Antimicrobial stewardship programme in a trauma centre of a tertiary care hospital in North India: Effects and implementation challenges

Verma, Madhur; Shafiq, Nusrat; Tripathy, Jaya Prasad; Nagaraja, Sharath Burugina; Kathirvel, Soundappan; Chouhan, Devendra Kumar; Arora, Pankaj; Singh, Tarundeep; Jain, Kajal; Gautam, Vikas; Dhillon, Mandeep Singh

doi:10.1016/j.jgar.2019.02.020

Cited by 15 publications

(37 citation statements)

References 13 publications

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“…We found significant reductions in the double anaerobic coverage, average number of antimicrobials prescribed per patient, as well as a decline in the defined daily doses (DDD) of designated antimicrobials within the study unit (38). In another study designed to assess the impact of AMS interventions on antimicrobial prescription in the tertiary care trauma center, significant improvements were noted in terms of duration, choice, indications and the route of administration of antimicrobials (39). Combined with the approach of monitoring of infection control practices, it was shown that further gains could be achieved in terms of DDD of designated antimicrobials, days of therapy (DOT) per 1,000 patient-days (PD) and length of therapy (LOT) per 1,000 PD (Data communicated for publication).…”

Section: Ams Challenges In Resource Limited Settingsmentioning

confidence: 81%

Antimicrobial Stewardship Programs in Resource Constrained Environments: Understanding and Addressing the Need of the Systems

Kakkar

Shafiq

Singh

et al. 2020

Front. Public Health

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Section: Ams Challenges In Resource Limited Settingsmentioning

confidence: 81%

Antimicrobial Stewardship Programs in Resource Constrained Environments: Understanding and Addressing the Need of the Systems

Kakkar

Shafiq

Singh

et al. 2020

Front. Public Health

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“…The norms and values of an organization, which are represented by the culture construct in the framework, were addressed in seven studies [ 41 , 50 , 58 , 62 , 68 , 77 , 81 ]. For example, interventions that were developed in the Western context and based on principles of democracy and teamwork were difficult to implement in organizations with a hierarchy culture [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research

Tannous

Haldane

et al. 2022

Implementation Sci

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Background Behavior change interventions that aim to improve rational antibiotic use in prescribers and users have been widely conducted in both high- and LMICs. However, currently, no review has systematically examined challenges unique to LMICs and offered insights into the underlying contextual factors that influence these interventions. We adopted an implementation research perspective to systematically synthesize the implementation barriers and facilitators in LMICs. Methods We conducted literature searches in five electronic databases and identified studies that involved the implementation of behavior change interventions to improve appropriate antibiotic use in prescribers and users in LMICs and reported implementation barriers and facilitators. Behavior change interventions were defined using the behavior change wheel, and the coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research (CFIR). Results We identified 52 eligible studies, with the majority targeting prescribers practicing at tertiary facilities (N=39, 75%). The most commonly reported factors influencing implementation were found in the inner setting domain of the CFIR framework, particularly related to constraints in resources and the infrastructure of the facilities where interventions were implemented. Barriers related to the external policy environment (e.g., lack of national initiatives and policies on antibiotic use), and individual characteristics of target populations (e.g., reluctance to change prescribing behaviors) were also common, as well as facilitators related to intervention characteristics (e.g., embedding interventions in routine practice) and process (e.g., stakeholder engagement). We also provided insights into the interrelationships between these factors and the underlying causes contributing to the implementation challenges in LMICs. Conclusion We presented a comprehensive overview of the barriers and facilitators of implementing behavior change interventions to promote rational antibiotic use in LMICs. Our findings suggest that facilitating the implementation of interventions to improve rational antibiotic use needs comprehensive efforts to address challenges at policy, organizational, and implementation levels. Specific strategies include (1) strengthening political commitment to prompt mobilization of domestic resources and formulation of a sustainable national strategy on AMR, (2) improving the infrastructure of health facilities that allow prescribers to make evidence-based clinical decisions, and (3) engaging local stakeholders to improve their buy-in and facilitate contextualizing interventions. Trial registration PROSPERO: CRD42021252715.

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“…Education is a major component of the whole ASP program. The expected outcome of an effective ASP are appropriate usage (choice, dose, route, and duration) of antimicrobials, less prophylactic therapy, and more empirical basis of prescriptions [73], In 2019, WHO released an ASP toolkit to guide healthcare facilities in low-and middle-income countries [74]. The toolkit provides general guidance for antimicrobial stewardship team structures, resources, and competencies that can help change antibiotic prescribing practices.…”

Section: Antimicrobial Stewardshipmentioning

confidence: 99%

“…The toolkit provides general guidance for antimicrobial stewardship team structures, resources, and competencies that can help change antibiotic prescribing practices. Although there is scientific evidence on the benefits of ASP implementation [73] and national, regional, and global guidance documents exist, there is a growing need for more specific guidance on how to establish, implement and evaluate effective ASPs at the healthcare facility level, especially in less developed nations [73]. These stewardship programs shall also focus on the impact of the speed of diagnosis; availability of drug susceptibility testing; pathogenspecific margins between expectations of spontaneous cure and treatment cure; state of bacterial infection on antimicrobial prescribing; timely and appropriate dosage, initiation, administration, and de-escalation of antimicrobials; and clinical outcomes of infection.…”

Section: Antimicrobial Stewardshipmentioning

confidence: 99%

Next Generation of AMR Network

et al. 2021

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Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity, especially in low-resource settings, and requires an interdisciplinary response across academia, government, countries, and societies. If unchecked, AMR will hamper progress towards reaching the United Nations Sustainable Development Goals (SDGs), including ending poverty and hunger, promoting healthy lives and well-being, and achieving sustained economic growth. There are many global initiatives to curb the effects of AMR, but significant gaps remain. New ways of thinking and operating in the context of the SDGs are essential to making progress. In this entry, we define the next generation of the AMR research network, its composition, and strategic activities that can help mitigate the threats due to AMR at the local, regional, and global levels. This is supported by a review of recent literature and bibliometric and network analyses to examine the current and future state of AMR research networks for global health and sustainable development.

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Antimicrobial stewardship programme in a trauma centre of a tertiary care hospital in North India: Effects and implementation challenges

Cited by 15 publications

References 13 publications

Antimicrobial Stewardship Programs in Resource Constrained Environments: Understanding and Addressing the Need of the Systems

Antimicrobial Stewardship Programs in Resource Constrained Environments: Understanding and Addressing the Need of the Systems

Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research

Next Generation of AMR Network

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