Antimicrobial Stewardship and Its Impact on the Changing Epidemiology of Polymyxin Use in a South Indian Healthcare Setting

Abstract

Polymyxins being last resort drugs to treat infections triggered by multidrug-resistant pathogens necessitates the implementation of antimicrobial stewardship program (ASP) initiatives to support its rational prescription across healthcare settings. Our study aims to describe the change in the epidemiology of polymyxins and patient outcomes following the implementation of ASP at our institution. The antimicrobial stewardship program initiated in February 2016 at our 1300 bed tertiary care center involved post-prescriptive audits tracking polymyxin consumption and evaluating prescription appropriateness in terms of the right indication, right frequency, right drug, right duration of therapy and administration of the right loading dose (LD) and maintenance dose (MD). Among the 2442 polymyxin prescriptions tracked over the entire study period ranging from February 2016 to January 2020, the number of prescriptions dropped from 772 prescriptions in the pre-implementation period to an average of 417 per year during the post-implementation period, recording a 45% reduction. The quarterly patient survival rates had a significant positive correlation with the quarterly prescription appropriateness rates (r = 0.4774, p = 0.02), right loading dose (r = 0.5228, p = 0.015) and right duration (r = 0.4361, p = 0.04). Our study on the epidemiology of polymyxin use demonstrated favorable effects on the appropriateness of prescriptions and mortality benefits after successful implementation of antimicrobial stewardship in a real-world setting.

Antimicrobial drug utilization pattern in a tertiary level intensive care unit in Northern India: Antimicrobial Stewardship Programme need of the hour

“…19 Another tertiary care hospital in south India for tackling the AMR and reducing the utilization of last resort antimicrobial polymixins for treating MDROs, implemented AMSP saw an outstanding reduction of 45% in the prescription of polymixins. 20 In this study, we find an alarmingly high utilization of antimicrobials including the last resort carbapenems and polymyxins in our ICU setups. Implementation of an effective AMSP is the best possible approach to tackle this high consumption of antimicrobial drugs.…”

Opportunities to enhance antibiotic stewardship: colistin use and outcomes in a low-resource setting

“…The efficacy of these changes at our institution is still to be investigated, but the implementation of an antimicrobial stewardship programme for colistin in another lower-middle-income country showed significant improvement across all measures. 36 Other facilities are urged to similarly audit colistin use to inform antibiotic stewardship and quality improvement processes. Education and training of healthcare workers on the safe and effective use of colistin is required and there are opportunities for the ID and microbiology teams to remain more involved, though care should be taken not to delay appropriate antibiotic initiation.…”

Uso de antimicrobianos no tratamento da neutropenia febril em pacientes pediátricos em um hospital de ensino

“…The survival rates were correlated with appropriate loading dose rates and appropriate treatment duration. Underdosing can lead to treatment failures, poor results and potential bacterial resistance development [25][26][27] . Teicoplanin also requires a loading dose of 12 mg/kg every 12 hours for 3 doses, followed by a maintenance dose of 6 mg/kg every 24 hours, according to the protocol guidelines, shown in Table 5.…”