OBJECTIVES:

Antimicrobial stewardship program (ASP) is one of the key strategies to reduce antimicrobial resistance and hospital acquired infection, a major dismay in India. The main objective of the study was to implement the ASP and to measure its impact at a tertiary care hospital.

METHODS:

This was a single-centre, quasi-experimental study done in Bengaluru, India. The required details were obtained from patient case notes and other medical records at the hospital. Justification forms were designed and physicians were detailed on the list of reserved antimicrobials, indications, institutional antimicrobial policy and other related information. The physicians were also instructed to state the reason for ordering of antimicrobials and obtain approval from antimicrobial stewardship team. The team reviewed the appropriateness of the therapy including duration of therapy, de-escalation, and compliance with ASP recommendations. The ASP focused on post-prescriptive audit with feedback, intervention and development of institutional guidelines.

The outcome of the program was assessed by comparing the consumption of the restricted antimicrobials, Defined daily dose (DDD) and Days of therapy (DOT) between the pre-implementation phase and post-implementation phase.

RESULTS :

A total of 6435 patients were included (3265 in the pre-implementation phase and 3170 in the post-implementation phase). A total of 2643 and 1674 justification forms in the pre-implementation phase and in the post-implementation phase were reviewed by the team and recommendations were provided to the end users. The percentage of patients treated with one or more antimicrobials decreased from 89.67 to 72.2%. DDDs decreased from 238.8 to 190.3 and DOT from 74.7 to 68.6. The overall reduction of antimicrobial utilisation was 32%, including a decrease of 28% for all reserved antimicrobials.

CONCLUSIONS :

Implementation of a multidisciplinary antibiotic stewardship program in hospital demonstrated a significant and robust impact on antibiotic utilisation and in avoidance of antimicrobial resistance in patients.