The Impact of Antimicrobial Stewardship Programme on Regulating the Policy Adherence and Antimicrobial Usage in Selected Intensive Care Units in a Tertiary Care Center - A Prospective Interventional Study

Chowdhury, Sushmita Sana; Sastry, Apurba; Sureshkumar, Sathasivam; Cherian, Anusha; Sistla, Sujatha; Rajashekar, Deepashree

doi:10.4103/ijmm.ijmm_20_326

Cited by 5 publications

(7 citation statements)

References 20 publications

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“…The included studies have been classified into four groups: 13 articles involved IP settings without a pharmacist as a part of an AMS-MDT intervention [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], 19 were carried out in IP settings with the inclusion of a pharmacist as a part of the intervention team [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ], eight articles engaged OP without a pharmacist [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ], while eight involved OP settings with a pharmacist [ 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Forty-one articles were from d...…”

Section: Resultsmentioning

confidence: 99%

“…Of those, seven scored high risk [ 33 , 34 , 46 , 57 , 59 , 63 , 67 ], three scored low risk [ 28 , 32 , 60 ], with one article only found to have some concerns [ 58 ]. On the other hand, the remaining 37 articles were non-randomized before and after methodology and were assessed using the ROBINS-1 assessment tool [ 24 , 25 , 26 , 27 , 29 , 30 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 61 , 62 , 64 , 65 , 66 , 68 , 69 , 70 , 71 ]. Out of those 37, 29 were at moderate risk of bias [ 24 , ...…”

Section: Resultsmentioning

confidence: 99%

“…On the other hand, the remaining 37 articles were non-randomized before and after methodology and were assessed using the ROBINS-1 assessment tool [ 24 , 25 , 26 , 27 , 29 , 30 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 61 , 62 , 64 , 65 , 66 , 68 , 69 , 70 , 71 ]. Out of those 37, 29 were at moderate risk of bias [ 24 , 25 , 29 , 30 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ,…”

Section: Resultsmentioning

confidence: 99%

“…Of the identified interventions, twelve were captured in the IP setting [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 37 , 38 , 39 , 40 , 42 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 53 , 54 , 55 ] while 13 were in the OP setting [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 68 , 69 , 70 , 71 ], with 7 common interventions between the two settings. Those interventions were prospective and audit with direct intervention [ 37 , 38 , 42 , 44 , 45 , 47 , 48 , 49 , 50 , 53 , …”

Section: Resultsmentioning

confidence: 99%

“…One study was conducted in the OP setting and pharmacists did not take part in the intervention [ 62 ]. On the other hand, insignificant changes were reported by all the six studies conducted in the IP setting [ 29 , 34 , 35 , 38 , 52 , 55 ]. The data from four IP studies have been pooled to produce an overall effect.…”

Section: Resultsmentioning

confidence: 99%

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Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

et al. 2022

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Antimicrobial stewardship interventions are targeted efforts by healthcare organizations to optimize antimicrobial use in clinical practice. The study aimed to explore effective interventions in improving antimicrobial use in hospitals. Literature was systemically searched for interventional studies through PubMed, CINAHL, and Scopus databases that were published in the period between January 2010 to April 2022. A random-effects model was used to pool and evaluate data from eligible studies that reported antimicrobial stewardship (AMS) interventions in outpatient and inpatient settings. Pooled estimates presented as proportions and standardized mean differences. Forty-eight articles were included in this review: 32 in inpatient and 16 in outpatient settings. Seventeen interventions have been identified, and eight outcomes have been targeted. AMS interventions improved clinical, microbiological, and cost outcomes in most studies. When comparing non-intervention with intervention groups using meta-analysis, there was an insignificant reduction in length of stay (MD: −0.99; 95% CI: −2.38, 0.39) and a significant reduction in antibiotics’ days of therapy (MD: −2.73; 95% CI: −3.92, −1.54). There were noticeable reductions in readmissions, mortality rates, and antibiotic prescriptions post antimicrobial stewardship multi-disciplinary team (AMS-MDT) interventions. Studies that involved a pharmacist as part of the AMS-MDT showed more significant improvement in measured outcomes than the studies that did not involve a pharmacist.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

et al. 2022

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Uso de antimicrobianos em hospital especializado em cardiologia

Bokehi,

Mascarenhas,

De Paula

2024

Rev. Cont. Saúde

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O gerenciamento do uso de antimicrobianos tem sido apontado como ação relevante para mitigar o uso irracional e a crescente resistência a esta classe de medicamentos. Desta forma, o presente estudo objetivou avaliar a utilização dos antimicrobianos mediante mensuração do consumo e avaliação de adequação do tratamento quanto à indicação, dose e duração, no período de agosto a novembro de 2019, em um hospital especializado em cardiologia. Os tratamentos iniciados de forma empírica também foram avaliados quanto à sua adequação após resultado de cultura e teste de sensibilidade a antimicrobianos, e, no caso de necessidade, à realização de ajuste. Ademais, aplicou-se a classificação da Organização Mundial de Saúde (OMS) em que os antimicrobianos são agrupados, conforme o impacto do seu uso na resistência microbiana e a importância do seu uso adequado e restrito, nas categorias Access, Watch e Reserve (AwaRe), a estes tratamentos. Foram avaliadas 1558 prescrições associadas a 405 tratamentos. As classes terapêuticas mais utilizadas foram as penicilinas combinadas, carbapenêmicos e cefalosporinas de terceira geração. A adequação na indicação foi observada em 84,2% dos casos. Dentre esses, 88,1% e 90,6% apresentavam, respectivamente, dose e duração do tratamento adequadas. Os tratamentos iniciados empiricamente foram realizados majoritariamente (58,7%) com antimicrobianos do grupo Watch, seguido do grupo Reserve (23,5%) e Access (17,8%). O ajuste de terapia foi realizado em 59% dos casos que os necessitavam (57,9%). Os resultaos sugerem que o uso de antimicrobianos deve ser aperfeiçoado, buscando minimizar o uso empírico, favorecer o uso de antimicrobianos da categoria Access e promover a adequação dos tratamentos empíricos após resultados de cultura.

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Health Policy Analysis on the Containment of Antimicrobial Resistance (AMR) in India: A Mixed Methods Study of Antimicrobial Stewardship as a Pivotal Intervention in Tackling AMR

Singh,

Pandey,

Singh

2024

AIA

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Objective: This policy report aimed at two goals, that is, to report the findings of the literature review and explore the perceptions of the key stakeholders in seeking better insight into the antimicrobial stewardship program (AMSP), and to develop antimicrobial resistance (AMR) policy recommendations for the Ministry of Health and Family Welfare (MoHFW), India, based on the findings from the rapid systematic review of the literature (both published and grey) and the views of key stakeholders. Method: A mixed method approach using literature review and qualitative interviews has been applied. A rapid systematic literature review focusing on the antimicrobial stewardship pro-gram’s key achievements and its implementation and impact, implementation challenges, gaps and barriers, and opportunities, has been carried out, which has been followed by conducting interviews of key stakeholders and reporting the findings along with the recommendations. Results: The findings have shown significant progress towards AMSP, such as expanding to 90 secondary-level hospitals and district-level hospitals/nursing homes, and the Indian Council of Medical Research antimicrobial resistance surveillance and research network (ICMR AMRSN) program. Education, training, and microbiological testing have been found to be the current focus areas. However, there exist challenges, including a lack of leadership support, diagnostic stew-ardship, and staffing of clinical pharmacists and infectious control nurses. Key gaps and barriers identified include setting up microbiology laboratories and hiring ICN nurses and clinical phar-macists. Opportunities have also been identified. Based on these findings, we have made succinct recommendations to address the themes and issues identified. Conclusion: Without new medicines, India will struggle to manage antimicrobial resistance. This situation calls for national oversight. This study has demonstrated AMSP as crucial for fighting this silent pandemic. The Indian government and policymakers must swiftly address critical chal-lenges, gaps, and opportunities. These findings and recommendations might potentially strengthen the future antimicrobial resistance national action plan (AMR NAP).

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The Impact of Antimicrobial Stewardship Programme on Regulating the Policy Adherence and Antimicrobial Usage in Selected Intensive Care Units in a Tertiary Care Center - A Prospective Interventional Study

Cited by 5 publications

References 20 publications

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

Uso de antimicrobianos em hospital especializado em cardiologia

Health Policy Analysis on the Containment of Antimicrobial Resistance (AMR) in India: A Mixed Methods Study of Antimicrobial Stewardship as a Pivotal Intervention in Tackling AMR

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