Impact of antimicrobial stewardship program on clinical outcomes in multidrug-resistant Gram-negative bacterial infections at a tertiary care hospital from South India

• Published in: National journal of physiology, pharmacy and pharmacology pharmacy and pharmacology, 2023, Vol.13 (9), p.1-678
• Main Authors: Rayadurgam, Venkata, Konda, Vijaya, R, Jayaprada, V, Manolasya, N, Ramakrishna
• Format: Article
• Language: English
• Subjects: Age; Antibiotics; Antimicrobial agents; Bacteria; Bacterial infections; Clinical outcomes; Consent; Developing countries; Disease control; Drug resistance; E coli; Gram-negative bacteria; Infections; Laboratories; LDCs; Length of stay; Medical records; Mortality; Multidrug resistant organisms; Observational studies; Pathogens; Patients; Sepsis; Surveillance
• ISSN: 2320-4672; 2231-3206
• DOI: 10.5455/njppp.2023.13.01020202318012023

Background: Increasing bacterial resistance to antimicrobial agents is resulting in high morbidity and mortality. Antimicrobial stewardship (AMS) programs aim at rationale use of antimicrobial agents in clinical settings by development and implementation of antibiotic policy. As the patterns of antimicrobial resistance vary with organism and time, there is a need for periodic surveillance. Aims and Objectives: The aim of the study was to study the impact of AMS program on appropriate use of antimicrobial agents and clinical outcomes in patients with multidrug-resistant Gram-negative bacterial (MDR GNB) infections. Materials and Methods: This is a prospective observational study that included patients diagnosed with multidrug-resistance Gram-negative bacterial infections during June to July 2019. Identification of multidrug-resistant organisms was performed as per clinical and laboratory standards institute guidelines 2016. Information on the use of empirical antibiotic and other antimicrobial agents after culture and sensitivity report were collected and assessed for appropriateness. All the patients were followed up till discharge. Results: From 170 patients, there were 211 specimens sent for culture and sensitivity and 249 pathogens were isolated. The most frequent pathogen isolated was Escherichia coli (42.6%) followed by Klebsiella spp. (22.9%). Isolates were most resistant to cefazolin (86.7%) and ceftriaxone (83.9%), and most sensitive to polymyxin B (100%) and tigecycline (97.2%). All patients were administered antimicrobial agents as per antibiotic policy of the institute and 154 (90.6%) patients have recovered from illness with a mean length of hospital stay of 19.4 ± 6.6 days. Conclusion: Adherence to antimicrobial policy helps in improved outcomes in patients with MDR GNB infections. Hence, the need to implement AMS program in all hospitals.