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1781. Impact of an Antimicrobial Stewardship Intervention in India: Evaluation of Post Prescription Review and Feedback as a Method of Promoting Optimal Antimicrobial Use
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 effect...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254053/ http://dx.doi.org/10.1093/ofid/ofy210.1437 |
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author | Rupali, Priscilla Zervos, Marcus J |
author_facet | Rupali, Priscilla Zervos, Marcus J |
author_sort | Rupali, Priscilla |
collection | PubMed |
description | 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. DISCLOSURES: P. Rupali, Merck Foundation: Grant Investigator, Grant recipient. M. J. Zervos, MedImmune, Merck Foundation: Consultant, Grant recipient. |
format | Online Article Text |
id | pubmed-6254053 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-62540532018-11-28 1781. Impact of an Antimicrobial Stewardship Intervention in India: Evaluation of Post Prescription Review and Feedback as a Method of Promoting Optimal Antimicrobial Use Rupali, Priscilla Zervos, Marcus J Open Forum Infect Dis Abstracts 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. DISCLOSURES: P. Rupali, Merck Foundation: Grant Investigator, Grant recipient. M. J. Zervos, MedImmune, Merck Foundation: Consultant, Grant recipient. Oxford University Press 2018-11-26 /pmc/articles/PMC6254053/ http://dx.doi.org/10.1093/ofid/ofy210.1437 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Rupali, Priscilla Zervos, Marcus J 1781. Impact of an Antimicrobial Stewardship Intervention in India: Evaluation of Post Prescription Review and Feedback as a Method of Promoting Optimal Antimicrobial Use |
title | 1781. Impact of an Antimicrobial Stewardship Intervention in India: Evaluation of Post Prescription Review and Feedback as a Method of Promoting Optimal Antimicrobial Use |
title_full | 1781. Impact of an Antimicrobial Stewardship Intervention in India: Evaluation of Post Prescription Review and Feedback as a Method of Promoting Optimal Antimicrobial Use |
title_fullStr | 1781. Impact of an Antimicrobial Stewardship Intervention in India: Evaluation of Post Prescription Review and Feedback as a Method of Promoting Optimal Antimicrobial Use |
title_full_unstemmed | 1781. Impact of an Antimicrobial Stewardship Intervention in India: Evaluation of Post Prescription Review and Feedback as a Method of Promoting Optimal Antimicrobial Use |
title_short | 1781. Impact of an Antimicrobial Stewardship Intervention in India: Evaluation of Post Prescription Review and Feedback as a Method of Promoting Optimal Antimicrobial Use |
title_sort | 1781. impact of an antimicrobial stewardship intervention in india: evaluation of post prescription review and feedback as a method of promoting optimal antimicrobial use |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254053/ http://dx.doi.org/10.1093/ofid/ofy210.1437 |
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