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Indian J Med Microbiol. 2019 Jul-Sep;37(3):309-317. doi: 10.4103/ijmm.IJMM_19_445.

Assessment of core capacities for antimicrobial stewardship practices in indian hospitals: Report from a multicentric initiative of global health security agenda.

Author information

1
Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, Kolkata, West Bengal, India.
2
Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, Kolkata, West Bengal, India.
3
Department of Orthopedics, All India Institute of Medical Sciences, Kolkata, West Bengal, India.
4
Department of Surgery, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India.
5
Department of Microbiology, Safdarjung Hospital and VMMC, Delhi, India.
6
Department of Surgical Disciplines, All India Institute of Medical Sciences, Kolkata, West Bengal, India.
7
Department of Gastroenterolog, All India Institute of Medical Sciences, Kolkata, West Bengal, India.
8
Department of Microbiology, All India Institute of Medical Sciences, Kolkata, West Bengal, India.
9
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Kolkata, West Bengal, India.
10
Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
11
Department of Infectious Diseases, Christian Medical College and Hospital, Vellore, India.
12
Department of Surgery, Christian Medical College and Hospital, Vellore, India.
13
Department of Pediatrics, Christian Medical College and Hospital, Vellore, India.
14
Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, India.
15
Department of Microbiology, P. D. Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India.
16
Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
17
Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
18
Department of Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
19
Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
20
Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
21
Department of Microbiology, Kasturba Medical College, Manipal, Karnataka, India.
22
Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India.
23
Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India.
24
Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
25
Department of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, Kolkata, West Bengal, India.
26
Department of Microbiology, Sir Ganga Ram Hospital, Kolkata, West Bengal, India.
27
Department of Microbiology, Tata Medical Centre, Kolkata, West Bengal, India.
28
Department of Microbiology, Armed Forces Medical College, Pune, Maharashtra, India.
29
Department of AIIMS, Bhopal, Madhya Prades, India.
30
Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
31
Department of Infection Control, Amrita School of Medicine, Kochi, Kerala, India.
32
Department of Microbiology, Apollo Hospital, Chennai, Tamil Nadu, India.
33
Department of Microbiology, Assam Medical College, Gwahati, Assam, India.
34
Department of Microbiology, Guahati Medical College, Gwahati, Assam, India.
35
Department of Microbiology, Institute of Post-Graduate Medical Education and Research, and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India.
36
Department of Microbiology, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India.
37
Department of Haematology, Tata Medical Center, Kolkata, West Bengal, India.
38
Department of Critical Care Medicine, Tata Medical Center, Kolkata, West Bengal, India.
39
Department of Surgical Oncology, Tata Medical Center, Kolkata, West Bengal, India.
40
Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India.
41
Department of Anaesthesiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
42
Department of Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
43
Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
44
Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
45
Department of Microbiology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
46
Department of Anaesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
47
Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
48
Department of Microbiology, Government Medical College, Surat, Gujarat, India.
49
Department of Critical Care and Respiratory Medicine, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India.
50
Department of Anaesthesiology and Critical Care, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India.
51
Department of Microbiology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India.
52
Department of Anaesthesiology and IC, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
53
Department of Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.

Abstract

Introduction:

Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs.

Subjects and Methods:

The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis.

Results and Conclusion:

The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.

KEYWORDS:

Antimicrobials; Global Health Security Agenda; India; assessment; stewardship

PMID:
32003327
DOI:
10.4103/ijmm.IJMM_19_445
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