Implementation and Impact of an Antimicrobial Stewardship Program at a Tertiary Care Center in South India.

Autor: Singh S; Department of Medical Administration, Amrita Institute of Medical Sciences, Kochi, India., Menon VP; Department of Internal Medicine, Amrita Institute of Medical Sciences, Kochi, India., Mohamed ZU; Department of Anaesthesiology and Critical Care Medicine, Amrita Institute of Medical Sciences, Kochi, India., Kumar VA; Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, India., Nampoothiri V; Department of Medical Administration, Amrita Institute of Medical Sciences, Kochi, India., Sudhir S; Department of Medical Administration, Amrita Institute of Medical Sciences, Kochi, India., Moni M; Department of Internal Medicine, Amrita Institute of Medical Sciences, Kochi, India., Dipu TS; Department of Internal Medicine, Amrita Institute of Medical Sciences, Kochi, India., Dutt A; Department of Medical Administration, Amrita Institute of Medical Sciences, Kochi, India., Edathadathil F; Department of Allied Health Sciences, Amrita Institute of Medical Sciences, Kochi, India., Keerthivasan G; Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, India., Kaye KS; Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor., Patel PK; Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor.; Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, Michigan.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2018 Nov 08; Vol. 6 (4), pp. ofy290. Date of Electronic Publication: 2018 Nov 08 (Print Publication: 2019).
DOI: 10.1093/ofid/ofy290
Abstrakt: Background: Antimicrobial resistance is a major public health threat internationally but, particularly in India. A primary contributing factor to this rise in resistance includes unregulated access to antimicrobials. Implementing antimicrobial stewardship programs (ASPs) in the acute hospital setting will help curb inappropriate antibiotic use in India. Currently, ASPs are rare in India but are gaining momentum. This study describes ASP implementation in a large, academic, private, tertiary care center in India.
Methods: An ASP was established in February 2016 consisting of an administrative champion, hospitalist, microbiologist, intensivist, and pharmacists. Antimicrobial stewardship program interventions included postprescriptive audit and establishment of institutional guidelines. The ASP tracked appropriate drug selection including loading dose, maintenance dose, frequency, route, duration of therapy, de-escalation, and compliance with ASP recommendations. Defined daily dose (DDD) of drugs and cost of antimicrobials were compared between the pre-implementation phase (February 2015-January 2016) and post-implementation phase (February 2016-January 2017).
Results: Of 48 555 patients admitted during the post-implementation phase, 1020 received 1326 prescriptions for restricted antibiotics. Antibiotic therapy was appropriate in 56% (742) of the total patient prescriptions. A total of 2776 instances of "inappropriate" antimicrobial prescriptions were intervened upon by the ASP. Duration (806, 29%) was the most common reason for inappropriate therapy. Compliance with ASP recommendations was 54% (318). For all major restricted drugs, the DDD/1000 patient days declined, and there was a significant reduction in mean monthly cost by 14.4% in the post-implementation phase.
Conclusions: Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, Indian hospital demonstrated feasibility and economic benefits.
Databáze: MEDLINE
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