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

Objectives: Hospital-based antimicrobial stewardship programmes (ASPs) aim to optimise antimicrobial use by employing a set of co-ordinated interventions. This study evaluated the implementation challenges of an ASP in a tertiary trauma care centre in India and its effect on antimicrobial prescription.

Methods: A pre- and post-intervention study design was used to compare the effects of the ASP amongst patients admitted during November 2017-January 2018. The appropriateness of antimicrobial prescriptions (dose, route, duration, indication, choice) was evaluated using a validated algorithm. ASP interventions involved daily audit and feedback, restriction on antibacterial usage, daily bedside review, education, and sensitisation activities for residents/nurses. Key implementation challenges and solutions were brainstormed in weekly meetings.

Results: A total of 695 patients were prescribed 1331 antimicrobials. There was a decrease in prophylactic antimicrobial use by 11% (P < 0.001). The prescription pattern improved significantly in the intervention phase compared with the pre-intervention phase in terms of duration, choice, indication and route of administration by 8%, 14%, 2% and 8% respectively. Patients in the intervention arm had significantly higher likelihood of receiving antimicrobials for an appropriate duration (aOR = 2.1, 95% CI 1.3-3.6; P = 0.004) and reason (aOR = 2.4, 95% CI 1.3-4.3; P = 0.003). Challenges identified in implementation included absence of an electronic recording system and inadequate orientation of treating doctors regarding rational antimicrobial use.

Conclusions: The ASP demonstrated significant improvement in antimicrobial usage. This model may be replicated in other hospital settings to promote rational use of antimicrobials.