Krishnamoorthy Yuvaraj, Govindan Dhanajayan, Karunakaran Monica, Parveen Muneera, Manohar Anaswara, Al-Tawfiq Jaffar A
Evidence Synthesis Unit, Partnerships for Research, Opportunities, Planning, Upskilling and Leadership (PROPUL) Evidence, Chennai, India.
Department of Community Medicine, ESIC Medical College and Hospital, Chennai, India.
IJID Reg. 2025 May 12;15:100666. doi: 10.1016/j.ijregi.2025.100666. eCollection 2025 Jun.
This systematic review was performed to assess the effectiveness and cost-effectiveness of antimicrobial stewardship programs (ASPs) in Indian tertiary care facilities.
Searches were performed in PubMed, Scopus, Cochrane Library, Google Scholar, Epistemonikos, and ScienceDirect up to July 2024. Data on antimicrobial consumption, resistance patterns, patient outcomes, and economic evaluations were extracted using standardized form. This review included 29 studies from various Indian states, and, due to heterogeneity in study type, narrative synthesis was performed.
ASP interventions-such as guideline implementation, antibiotic prescription audits with feedback, and clinician education-were associated with significant reductions in overall antibiotic use (up to 32% reduction in neonatal intensive care units) and improvements in resistance patterns (decrease in methicillin-resistant and vancomycin-resistant Enterococcus rates). Patient-related outcomes, including reduced length of hospital stay and lower rates of health care-associated infections, were observed, although changes in mortality were variable. Economic analyses demonstrated substantial cost savings and favorable cost-effectiveness profiles.
ASPs in Indian tertiary care settings are clinically effective and economically viable, reducing antimicrobial misuse, curbing resistance, and improving patient outcomes, while lowering health care costs. Further research using standardized metrics and extending to other health care levels is needed to optimize and sustain ASP benefits.
本系统综述旨在评估抗菌药物管理计划（ASPs）在印度三级医疗机构中的有效性和成本效益。
截至2024年7月，在PubMed、Scopus、Cochrane图书馆、谷歌学术、Epistemonikos和ScienceDirect上进行了检索。使用标准化表格提取了抗菌药物消费、耐药模式、患者结局和经济评估的数据。本综述纳入了来自印度不同邦的29项研究，由于研究类型存在异质性，因此进行了叙述性综合分析。
抗菌药物管理计划干预措施，如指南实施、有反馈的抗生素处方审核以及临床医生教育，与总体抗生素使用量的显著减少（新生儿重症监护病房最多减少32%）以及耐药模式的改善（耐甲氧西林和耐万古霉素肠球菌率降低）相关。观察到与患者相关的结局，包括住院时间缩短和医疗保健相关感染率降低，尽管死亡率的变化各不相同。经济分析表明节省了大量成本，且成本效益情况良好。
印度三级医疗机构中的抗菌药物管理计划在临床上有效且在经济上可行，可减少抗菌药物滥用、遏制耐药性并改善患者结局，同时降低医疗保健成本。需要使用标准化指标并扩展到其他医疗保健层面进行进一步研究，以优化并维持抗菌药物管理计划的益处。
