Impact of an antimicrobial stewardship intervention in India: Evaluation of post-prescription review and feedback as a method of promoting optimal antimicrobial use in the intensive care units of a tertiary-care hospital

• Published in: Infection control and hospital epidemiology 2019-05, Vol.40 (5), p.512-519
• Main Authors: Rupali, Priscilla, Palanikumar, Prasannakumar, Shanthamurthy, Divyashree, Peter, John Victor, Kandasamy, Subramani, Zacchaeus, Naveena Gracelin Princy, Alexander, Hanna, Thangavelu, Premkumar, Karthik, Rajiv, Abraham, Ooriapadickal Cherian, Michael, Joy Sarojini, Paul, Hema, Veeraraghavan, Balaji, Chacko, Binila, Jeyaseelan, Visalakshi, Alangaden, George, Prentiss, Tyler, Zervos, Marcus J
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Antimicrobial Stewardship - methods; Child; Consultants; Developed countries; Disease control; Drug resistance; Drug Utilization - statistics & numerical data; Female; Health Promotion - methods; Hospital Mortality; Hospitals; Humans; Inappropriate Prescribing - statistics & numerical data; India - epidemiology; Infectious diseases; Intensive care; Intensive Care Units; Intervention; Laboratories; Male; Medical records; Middle Aged; Mortality; Nosocomial infections; Nursing; Patients; Pharmacists; Physicians; Pilot Projects; Practice Patterns, Physicians' - statistics & numerical data; Prescriptions; Prospective Studies; Staphylococcus infections; Tertiary Care Centers; Training; Young Adult
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2019.29

Antimicrobial stewardship programs (ASPs) are effective in developed countries. In this study, we assessed the effectiveness of an infectious disease (ID) physician-driven post-prescription review and feedback as an ASP strategy in India, a low middle-income country (LMIC). This prospective cohort study was carried out for 18 months in 2 intensive care units of a tertiary-care hospital, consisting of 3 phases: baseline, intervention, and follow up. Each phase spanned 6 months. Patients aged ≥15 years receiving 48 hours of study antibiotics were recruited for the study. During the intervention phase, an ID physician reviewed the included cases and gave alternate recommendations if the antibiotic use was inappropriate. Acceptance of the recommendations was measured after 48 hours. The primary outcome of the study was days of therapy (DOT) per 1,000 study patient days (PD). Overall, 401 patients were recruited in the baseline phase, 381 patients were recruited in the intervention phase, and 379 patients were recruited in the follow-up phase. Antimicrobial use decreased from 831.5 during the baseline phase to 717 DOT per 1,000 PD in the intervention phase (P < .0001). The effect was sustained in the follow-up phase (713.6 DOT per 1,000 PD). De-escalation according to culture susceptibility improved significantly in the intervention phase versus the baseline phase (42.7% vs 23.6%; P < .0001). Overall, 73.3% of antibiotic prescriptions were inappropriate. Recommendations by the ID team were accepted in 60.7% of the cases. The ID physician-driven implementation of an ASP was successful in reducing antibiotic utilization in an acute-care setting in India.