Practice of antimicrobial stewardship in a government hospital of India and its impact on extended point prevalence of antibiotic usage

Shweta Kumar; Karuna Tadepalli; Rajnish Joshi; Manisha Shrivastava; Rajesh Malik; Pradeep Saxena; Saurabh Saigal; Ratinder Jhaj; Sagar Khadanga

doi:10.4103/jfmpc.jfmpc_1473_20

Practice of antimicrobial stewardship in a government hospital of India and its impact on extended point prevalence of antibiotic usage

J Family Med Prim Care. 2021 Feb;10(2):991-997. doi: 10.4103/jfmpc.jfmpc_1473_20. Epub 2021 Feb 27.

Authors

Shweta Kumar¹, Karuna Tadepalli², Rajnish Joshi¹, Manisha Shrivastava³, Rajesh Malik⁴, Pradeep Saxena⁵, Saurabh Saigal⁶, Ratinder Jhaj⁷, Sagar Khadanga¹

Affiliations

¹ Department of General Medicine, AIIMS Bhopal, Madhya Pradesh, India.
² Department of Microbiology, AIIMS Bhopal, Madhya Pradesh, India.
³ Department of Medical Superintendent, AIIMS Bhopal, Madhya Pradesh, India.
⁴ Department of Radiodiagnosis, AIIMS Bhopal, Madhya Pradesh, India.
⁵ Department of General Surgery, AIIMS Bhopal, Madhya Pradesh, India.
⁶ Department of Anesthesia and Critical Care, AIIMS Bhopal, Madhya Pradesh, India.
⁷ Department of Pharmacology, AIIMS Bhopal, Madhya Pradesh, India.

Abstract

Background: Antimicrobial resistance (AMR) is a global concern requiring immediate attention. Among many proven measures of decreasing AMR, practice of antimicrobial stewardship is the lowest hanging which can be adapted with negligible financial implications.

Methods: This is a case record based extended cross-sectional type of observational operation research study conducted at an institute of national importance established by Government of India. Point prevalence of antibiotic usage among the patients admitted in the hospital, on four different days in four different quarters of a year was done to study the impact of antimicrobial stewardship program (AMSP).

Results: A cumulative 711 patients were exposed on antibiotics among 1396 study participants. There was a significant decrease in antibiotic consumption across the 1^st and 4^th quarter. The average antibiotic usage was 50.9% (61.75, 60%, 48.4%, and 39% respectively in the 1^st to 4^th quarter). Among the total number of patients, intravenous antibiotic usage was 47.9% (60.71%, 58.4%, 44.9%, and 34.2% respectively in 1^st to 4^th quarter). Among the newly admitted patients, the consumption of antibiotic usage decreased from 45.9% to 25.7%. Among the intravenous antibiotics, the top 10 consumed antibiotics were 3^rd generation cephalosporin (39.8%), aminoglycoside (14.8%), amoxicillin/amoxy-clav (12.5%), piperacillin-tazobactum (8.5%), carbapenams (6.6%), cefuroxime (6.4%), quinolones (4.3%), vancomycin/linezolid (4.1%), colistin (0.8%), and others (0.8%).

Conclusion: Government run hospitals can run low budget antimicrobial stewardship program with sustainable impact on antibiotic consumption. For a successful AMSP, it requires change in attitude, commitment, and administrative support rather than a huge financial support.

Keywords: Antibiotic consumption; antibiotic usage; antimicrobial resistance; antimicrobial stewardship; point prevalence of antibiotic.