Establishing an effective antimicrobial stewardship program at four secondary-care hospitals in India using a hub-and-spoke model

• DOI: 10.1017/ash.2023.171
• Publication Date: 2023-06-09T08:29:32Z
• Authors: Naveena Gracelin ...; Prasannakumar Pal...; Hanna Alexander; Jemin Webster; Indu K. Nair; Mahima Sadanshiv; Rincy Merlin Thomas; Divya Deodhar; Prasanna Samuel; Priscilla Rupali
• Keywords: Antimicrobial Stewardship; Baseline (sea)

The high burden of antimicrobial resistance in India necessitates the urgent implementation stewardship programs (ASPs) all healthcare settings India. Most ASPs are based at tertiary-care centers, with sparse data available regarding effectiveness an ASP a low-resource primary/secondary-care setting.We adopted hub-and-spoke model to implement 4 low-resource, secondary-care settings. study included 3 phases measuring consumption data. In baseline phase, we measured days on therapy (DOTs) no feedback provided. This was followed by customized intervention package. postintervention prospective review and were offered trained physician or pharmacist, (DOT) measured.In 1,459 patients from sites enrolled; 1,233 enrolled phase. Both groups had comparable characteristics. key outcome, DOT per 1,000 patient days, 1,952.63 phase significantly lower post-intervention period, 1,483.06 (P = .001). Usage quinolone, macrolide, cephalosporin, clindamycin, nitroimidazole decreased Also, rate antibiotic de-escalation higher than (44% vs 12.5%; P < .0001), which suggests definite trend toward judicious use antibiotics. 79.9% justified. Overall, recommendations given team fully 946 cases (77.7%), partially 59 (4.8%), not 137 (35.7%). No adverse events noted.Our successful implementing hospitals India, urgently needed.