1781. Impact of an Antimicrobial Stewardship Intervention in India: Evaluation of Post Prescription Review and Feedback as a Method of Promoting Optimal Antimicrobial Use

Abstract

Background. Antimicrobial stewardship programs (AMSP) are effective in developed countries. This study assessed the effectiveness of an AMSP in a low middle-income country like India. Methods. An Infectious Diseases (ID) physician-driven prospective audit and feedback strategy to evaluate the effectiveness of an AMSP in two intensive care settings of a tertiary care hospital was performed from January 2016 to July 2017 in three phases: baseline, intervention and follow-up each consisting of 6 months. In the baseline and follow-up period, relevant data were recorded. In the intervention phase a patient on antibiotics for >48 hours was assessed by an ID physician and recommendations made. Primary outcome was days on antimicrobial therapy (DOT) and other secondary outcomes were assessed. Results. A total of 401, 381, and 379 patients were recruited in the baseline, intervention, and follow-up phases. Baseline characteristics of the three groups were similar. Antimicrobial use decreased from 831.5 during baseline to 717 DOT per 1,000 patient days in the intervention (P < 0.0001) and the effect was sustained in the follow-up period (713.6 DOT per 1,000 patient-days). Among the study antimicrobials, DOTs were significantly lower in the intervention vs. baseline phase for Quinolones (21.5 vs. 33.3), Carbapenems (340.2 vs. 426.0) and Colistin (131.5 vs. 155.9) (P < 0.0001). De-escalation according to culture susceptibility was significantly higher in the intervention group compared with the baseline (42.7% vs. 23.6%; P < 0.0001). Compliance to hospital-based antibiotic guidelines significantly improved in intervention and follow-up phases compared with the baseline (19.5%, 21.8%, 33.2%; P < 0.0001). We found that 73.3% of antibiotic prescriptions were inappropriate and commonly occurred in the absence of an appropriate clinical indication. Recommendations by the ID team were accepted in 60.7% of the cases. All-cause in hospital mortality rates were 22.4% and 27.6% in the baseline and intervention phases respectively (P = 0.093). Conclusion. An ID physician-driven antimicrobial stewardship programme was successful in reducing antibiotic utilization without compromising patient safety in low and middle-income countries; however, this needs further validation.