Impact of Antibiotic Stewardship Program on Prescribing Pattern of Antimicrobials in Patients of Medical Intensive Care Unit

Shah, Nishal; Joshi, Anuradha; Ganguly, Barna

doi:10.7860/jcdr/2017/27171.10237

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…AMS is a set of coherent activities that results in responsible use of antibiotics, with the definition of responsible use being context-specific and updated periodically ( 3 ). The role of AMS in a healthcare facility has been demonstrated through various studies ( 4 – 6 ). These studies show significant reduction in use of antimicrobials, expenditure associated with antimicrobial use and levels of resistance among various indicator pathogens.…”

Section: Introductionmentioning

confidence: 99%

Challenges in Implementing Antimicrobial Stewardship Programmes at Secondary Level Hospitals in India: An Exploratory Study

Mathew

Ranjalkar

Chandy

2020

Front. Public Health

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Introduction: Implementing a sustainable and effective Antimicrobial Stewardship (AMS) programme in secondary level hospitals, in Low-Middle Income Country (LMIC) contexts, has numerous challenges. It is important to understand these challenges so that the stewardship initiatives can be tailored according to the unique requirements thrown up by these healthcare facilities. This study explores the experiences of implementing AMS in secondary level hospitals in the state of Kerala, India. Methods: A qualitative study was planned to map the challenges in implementing AMS in the secondary level hospitals. Toward the end of the 1 year followup period, the nodal officers at each hospital were interviewed using a semi-structured interview guide. The in-depth interviews were transcribed and later subjected to content analysis using N-Vivo 11.0, a popular software tool used for qualitative analysis. Results: Many physicians cite perceived patient satisfaction as one of the reasons for increased antibiotic use, as many patients consider antibiotics as standard of care. Also, the distance traveled by the patient and advancing age are factors which increase antibiotic use. The physician factors which determine use include empiric treatment needs, outbreak of diseases, absence of education programmes in antibiotic usage to fill in the knowledge gap and fear of litigation. The promotional activities by companies and antibiotics being a major source of income for small hospitals, affects use patterns. The factors which determine antibiotic selection includes conformism, experience of the physician, perceived resistance to certain antibiotics, emergence of specific diseases, and promotional activities related to antimicrobial agents. The challenges in implementing a sustainable stewardship programme is multifactorial. It includes competition between doctors, time constraints faced by physicians, absence of a champion, sub-optimal interdepartmental cooperation, absence of supporting facilities, dysfunctional regulatory systems, and unreliability of antibiograms. Discussion: AMS in resource-limited setting is going to be a challenge, especially in terms of financing, access to technologies and capacity building. Political and regulatory Mathew et al. Challenges in Antimicrobial Stewardship Implementation willpower of international partnerships should be effectively harnessed for designing solutions for LMIC contexts. Also, models for stewardship from elsewhere should undergo an adaptation process before implementation in low resource settings.

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Section: Introductionmentioning

confidence: 99%

Challenges in Implementing Antimicrobial Stewardship Programmes at Secondary Level Hospitals in India: An Exploratory Study

Mathew

Ranjalkar

Chandy

2020

Front. Public Health

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“…Still, we recognise low/middle-income countries (LMIC) face ASP implementation challenges including limited diagnostic laboratory capability, inadequate awareness, limited access to quality antibiotics and high patient census 15. To date, few studies have explored the challenges facilities in India face carrying out ASPs, such as less available manpower and money dedicated to maintaining a detailed electronic medical record (EMR) compared with higher-income country counterparts 16–18. EMR systems have been found to be one of the most effective ways of keeping records on patient care and allow for easier discussion and feedback on antibiotic choices 17.…”

Section: Introductionmentioning

confidence: 99%

Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study

et al. 2019

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ObjectivesTo determine what barriers and facilitators to antibiotic stewardship exist within a healthcare facility.Setting1300-bed tertiary care private hospital located in the state of Kerala, India.Participants31 semistructured interviews and 4 focus groups with hospital staff ranging from physicians, nurses, pharmacists and a clinical microbiologist.ResultsKey facilitators of antibiotic stewardship (AS) at the hospital included a dedicated committee overseeing appropriate inpatient antibiotic use, a prompt microbiology laboratory, a high level of AS understanding among staff, established guidelines for empiric prescribing and an easily accessible antibiogram. We identified the following barriers: limited access to clinical pharmacists, physician immunity to change regarding stewardship policies, infrequent antibiotic de-escalation, high physician workload, an incomplete electronic medical record (EMR), inadequate AS programme (ASP) physical visibility and high antibiotic use in the community.ConclusionsOpportunities for improvement at this institution include increasing accessibility to clinical pharmacists, implementing strategies to overcome physician immunity to change and establishing a more accessible and complete EMR. Our findings are likely to be of use to institutions developing ASPs in lower resource settings.

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“…14 An Indian study showed that 93.3% of the antibiotic use in ICU was for therapeutic use and 89.3% antimicrobial prescriptions were adherent to the hospital antibiotic policy. 15 A prospective observational study found antibiotic use longer than the recommended duration (33.3%) and use in non-infectious conditions (32.4%). 16 In yet another study, 64.1% of prescriptions were appropriate which increased to 77.4% after a 12 month follow up.…”

Section: Discussionmentioning

confidence: 99%

A Study on Appropriateness of Antibacterial Use in Acute Wards of a Teaching Hospital

Jaiswal¹,

Shyam²,

Yadav³

2020

J. Drug Delivery Ther.

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Objective: A study to analyse the appropriateness of use of antibacterials in acute wards of a tertiary care hospital. Design: A pharmacoepidemiological research study. Intervention: Non-interventional descriptive study. Main Outcome Measure: The antibacterial prescriptions were analyzed for their adherence to or deviation from the standard national treatment guidelines. Results: There were a total of 207 patients comprising of 35 in acute medical ward, 65 in ICU, 53 in acute surgical ward and 54 in family ward, who were prescribed antibacterials. These consisted of a total of 383 prescription counts for appropriateness of AMA use. One third of the antibacterial prescriptions of inpatients surveyed were for prophylactic use followed by the treatment of respiratory and gastrointestinal diseases. The highest prescription counts were seen with carbapenems followed by nitroimidazoles, cephalosporins, aminoglycosides and penicillins. 99% of the prescriptions were appropriate for the dose used and 49.6% of the prescriptions were inappropriate for duration of use. 74.5% of the surgical prophylaxis prescriptions were used for more than 24 hours. Ceftriaxone and cefotaxime were used instead of the recommended cefazolin, for prophylaxis. High percentage of deviation was observed with prescriptions of cefotaxime and metronidazole for empirical use. No definitive use of antimicrobials for infections was observed in the ICU. Conclusion: A high percentage of appropriateness was observed for dose of antibiotic used. The main targets identified for improvement are duration of antimicrobial use, choice of drug for surgical prophylaxis and the definitive use of antimicrobial agents. Keywords: adherence to treatment guidelines, antibiotic audit, antimicrobials.

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Impact of Antibiotic Stewardship Program on Prescribing Pattern of Antimicrobials in Patients of Medical Intensive Care Unit

Abstract: In-depth analysis of the study revealed a positive impact of ASP and antibiotic policy. Implementation of ASP in year 2013, brought an effective increase in the appropriate use of antimicrobials.

Cited by 5 publications

References 18 publications

Challenges in Implementing Antimicrobial Stewardship Programmes at Secondary Level Hospitals in India: An Exploratory Study

Challenges in Implementing Antimicrobial Stewardship Programmes at Secondary Level Hospitals in India: An Exploratory Study

Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study

A Study on Appropriateness of Antibacterial Use in Acute Wards of a Teaching Hospital

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