Zacchaeus Naveena Gracelin Princy, Palanikumar Prasannakumar, Alexander Hanna, Webster Jemin, Nair Indu K, Sadanshiv Mahima, Thomas Rincy Merlin, Deodhar Divya, Samuel Prasanna, Rupali Priscilla
Department of Infectious Diseases, Christian Medical College, Vellore, Tamilnadu, India.
Baptist Christian Hospital, Tezpur, Assam, India.
Antimicrob Steward Healthc Epidemiol. 2023 Jun 9;3(1):e99. doi: 10.1017/ash.2023.171. eCollection 2023.
The high burden of antimicrobial resistance in India necessitates the urgent implementation of antimicrobial stewardship programs (ASPs) in all healthcare settings in India. Most ASPs are based at tertiary-care centers, with sparse data available regarding the effectiveness of an ASP in a low-resource primary/secondary-care setting.
We adopted a hub-and-spoke model to implement ASPs in 4 low-resource, secondary-care healthcare settings. The study included 3 phases measuring antimicrobial consumption data. In the baseline phase, we measured days on antimicrobial therapy (DOTs) with no feedback provided. This was followed by the implementation of a customized intervention package. In the postintervention phase, prospective review and feedback were offered by a trained physician or ASP pharmacist, and days of therapy (DOT) were measured.
In the baseline phase, 1,459 patients from all 4 sites were enrolled; 1,233 patients were enrolled in the postintervention phase. Both groups had comparable baseline characteristics. The key outcome, DOT per 1,000 patient days, was 1,952.63 in the baseline phase and significantly lower in the post-intervention period, at 1,483.06 ( = .001). Usage of quinolone, macrolide, cephalosporin, clindamycin, and nitroimidazole significantly decreased in the postintervention phase. Also, the rate of antibiotic de-escalation was significantly higher in the postintervention phase than the baseline phase (44% vs 12.5%; < .0001), which suggests a definite trend toward judicious use of antibiotics. In the postintervention phase, 79.9% of antibiotic use was justified. Overall, the recommendations given by the ASP team were fully followed in 946 cases (77.7%), partially followed in 59 cases (4.8%), and not followed in 137 cases (35.7%). No adverse events were noted.
Our hub-and-spoke model of ASP was successful in implementing ASPs in secondary-care hospitals in India, which are urgently needed.
印度抗菌药物耐药负担沉重，因此有必要在印度所有医疗机构中紧急实施抗菌药物管理计划（ASP）。大多数ASP以三级医疗中心为基础，关于ASP在资源匮乏的初级/二级医疗机构中的有效性的数据很少。
我们采用了一种中心辐射模式，在4个资源匮乏的二级医疗机构中实施ASP。该研究包括3个阶段，测量抗菌药物消费数据。在基线阶段，我们测量了抗菌药物治疗天数（DOTs），未提供反馈。随后实施了定制的干预方案。在干预后阶段，由经过培训的医生或ASP药剂师进行前瞻性审查和反馈，并测量治疗天数（DOT）。
在基线阶段，来自所有4个地点的1459名患者入组；干预后阶段有1233名患者入组。两组的基线特征具有可比性。关键结果是每1000个患者日的DOT，在基线阶段为1952.63，在干预后时期显著降低，为1483.06（P = 0.001）。喹诺酮类、大环内酯类、头孢菌素类、克林霉素和硝基咪唑类的使用在干预后阶段显著减少。此外，干预后阶段抗生素降阶梯率显著高于基线阶段（44%对12.5%；P < 0.0001），这表明抗生素合理使用有明确趋势。在干预后阶段，79.9%的抗生素使用是合理的。总体而言，ASP团队给出的建议在946例（77.7%）中得到完全遵循，在59例（4.8%）中部分遵循，在137例（11.2%）中未遵循。未观察到不良事件。
我们的ASP中心辐射模式在印度急需的二级医院成功实施了ASP。
