Evaluation of Antibiotic Stewardship Programs in India Through a Pilot Needs Assessment Model

Author(s):
Abhinay Tumati; Harjot K Singh; Manjari Joshi; Philip S Barie; Mayur Narayan

Background:

Surgical Site Infections (SSI) are common yet preventable complications. Antibiotic stewardship programs (ASP) can mitigate SSI. While there are recent U.S. Centers for Disease Control (CDC), World Health Organization (WHO), and Indian Council of Medical Research (ICMR) guidelines on ASP for resource-limited settings, implementation globally has lagged. In India, there are few data on SSI and even less is known about ASP and its potential role.

Hypothesis:

In this survey, we aim to understand the current state of ASP and SSI surveillance at 5 Indian hospitals.

Methods:

A prospective survey of 5 Indian academic medical centers, selected for geographic dispersion, was conducted. We collected descriptive variables about the hospitals’ existing ASP programs/infrastructure, surgical volume, SSI counts, and percentage of multidrug-resistant organisms (MDRO) by specialty (obstetrics, pediatrics, adult) between 2017-2021. Data were collected in REDCap and analyzed in Microsoft Excel.

Results:

Three of the five (60%) centers completed the survey. Inpatient surgical bed capacity ranged from 392 to 1269. All 3 institutes performed SSI surveillance, with varying frequency (i.e., daily to monthly). Two centers had formal patient safety monitoring and infection prevention committees; however, none had an ASP committee. Only one had formal education on patient preparation for surgery, skin antisepsis, or antimicrobial resistance/ASP. All 3 centers had an accessible microbiology lab but only one institution had a pharmacy system to provide data on antimicrobial utilization. SSIs were reported at all centers, but the majority were superficial incisional SSI (range 72-100%). During the 5-y period, the mean frequency of MDRO were, specifically MRSA, ESBL, and CRE 3.9% (range 1.5%-11.5%), 32.7% (range 15.1%-57.4%), and 16.0% (range 3.7-30.0%), respectively.

Conclusions:

In surveyed academic medical centers in India, there is wide variation in SSI prevention and surveillance practices, including data collection/dissemination, as well as differences in availability of education/guidelines for providers. SSI were prevalent in adults, but data were limited for obstetrics and pediatric services (data not shown). In general, high frequency of MDRO were seen but with wide variation. Multiple opportunities exist to standardize ASP toward reducing SSI in India, but lack of infrastructure poses substantial barriers.