# Impact of Antimicrobial Stewardship on Antimicrobial Utilization and Resistance Patterns in a Tertiary Care Hospital in Western Maharashtra

## TL;DR

This study shows that an antimicrobial stewardship program significantly reduced antibiotic use and resistance in a hospital in western Maharashtra.

## Contribution

The study demonstrates the effectiveness of an AMS program in reducing antibiotic consumption and resistance in a private tertiary care hospital in India.

## Key findings

- Antibiotic consumption decreased significantly after the AMS program was implemented.
- Resistance to gentamicin, amikacin, and teicoplanin decreased following the intervention.
- Culture-based therapy and surgical prophylaxis compliance improved substantially.

## Abstract

Background: Non-judicious use of antibiotics by health professionals has been identified as an area for interventions and improvement by the World Health Organization for controlling antimicrobial resistance. Following the Indian Council for Medical Research (ICMR) guidelines, we established an antimicrobial stewardship (AMS) program at the 950-bedded multispecialty private sector hospital located in western Maharashtra by the end of the year 2021.

Aim and objective: The purpose of this study was to evaluate the impact of an AMS program intervention on the utilization of antibiotics and resistance patterns of organisms isolated from the patients.

Result: A significant reduction in the utilization of ceftriaxone (23.3 to 6.75), piperacillin-tazobactam (7.7 to 6.0), amikacin (9.03 to 5.15), clindamycin (6.25 to 5.75), linezolid (5.8 to 4.8), and ceftazidime (0.9 to 0.2) in defined daily doses (DDD/100 bed days) was seen after intervention. Antibiotic resistance decreased in gentamicin, amikacin, and teicoplanin. Overall antibiotic consumption reduced from 1,681.0 to 1,420.0 DDD/100 days. Culture-based therapy increased from 61% to 90%. Surgical prophylaxis compliance increased from 58% to 96%.

Conclusion: The constant perseverance of the AMS team of our hospital had a positive impact on reducing the overall consumption of antibiotics. Stringent infection prevention and control practices, timely provision of treatment guidelines, frequent interactions and discussions with treating doctors, audits by clinical pharmacists, and feedback to the doctors along with various training programs and sensitization sessions by the AMS team have brought significant behavioral changes among the treating physicians.