Experience of rigorous practice of antimicrobial stewardship program and its impact on antibiotic consumption

Abstract

Antimicrobial resistance (AMR) is the next pandemic with a huge global economic burden. A customized antimicrobial stewardship program (AMSP) is a well-recognized tool for containment of AMR. The current study was undertaken to identify the impact of AMSP measures on the trends of antibiotic consumption rates, e.g., defined daily dose (DDD) and days of therapy (DOT) per 100 patient days in pre-identified areas of the hospital. The present study was a case-record-based extended cross-sectional study carried out in a tertiary care institute in central India from January 2021 to September 2021. Time-bound feasible sampling was undertaken, and all cases were included without any exclusion criteria. The study was approved by the Ethics Committee of the Institute and funded by the Indian Council of Medical Research (ICMR). The data was entered into a spreadsheet. The calculation of DDD and DOT was performed individually for each antibiotic as per WHO tool per 100 patient days. In high-priority areas such as intensive care unit and high dependency unit, the top three DDD/100 days were meropenem (77.9), colistin (41.4), and piperacillin-tazobactam (13.5) versus the top 3 DOT/100 patient days were meropenem (40.5), colistin (20.9), and piperacillin-tazobactam (15.7). In low-priority areas such as general wards, the top 3 DDD/100 patient days were meropenem (45.4), piperacillin-tazobactam (22.6), and cefoperazone (5.0) versus the top three DOT/100 patient days were meropenem (45.4), cefoperazone (44.9), and piperacillintazobactam (22.6). There was a downward trend of consumption of almost all these antibiotics when measured at baseline and the next two quarters. DDD and DOT per 100 patient days had a positive linear correlation during the study period. The present study demonstrates about 50% reduction in consumption of ICMR priority antibiotics with a yearlong AMSP. DDD and DOT per 100 patient days can be calculated with minimal effort, even in extremely busy hospitals. DOT tools are less labor-intensive and, hence, should be the pivotal tool for antibiotic exposure measurement.