Antibiotic stewardship in a tertiary care hospital of a developing country: establishment of a system and its application in a unit-GASP Initiative.
OBJECTIVE
Despite the proven benefits of antimicrobial stewardship, models for executing the same in the developing countries are sparse. The present study highlights the approaches undertaken by our group in initiating one such program in a public sector tertiary level health care setting of a developing country.


METHODS
The study focussed on development of a system after evaluation of existing issues and case study of implementation of the program in a unit within the hospital. The system building exercise included (1) development of generic data capture form for prospective audit and feedback; (2) development of an electronic system for data capture; (3) identification of key intervention points for strategy decision for stewardship in a particular unit; (4) application of the stewardship method and (5) evaluation of outcomes.


RESULTS
A digital system for prospective audit was constructed after a background study. In the study unit, there was a significant decline in double anaerobic coverage. There was a significant decline in the average number of antimicrobials used per patients and a decrease in Defined Daily Dose of designated antimicrobials was noted. Additionally, there was an increase in the use of optimized doses.


CONCLUSIONS
A system for undertaking antimicrobial stewardship with a mechanism for prospective audit was put in place. The system may be adopted by other public sector hospitals of the developing country.
Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. nusha.pgi2302@yahoo.com.
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Shafiq
Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Praveen Kumar
Department of Medical Microbiology, PGIMER, Chandigarh, 160012, India.
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Gautam
Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Negi
Department of General Surgery, PGIMER, Chandigarh, 160012, India.
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Roat
Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Malhotra
Department of Medical Microbiology, PGIMER, Chandigarh, 160012, India.
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Ray
Department of Pulmonary Medicine, PGIMER, Chandigarh, 160012, India.
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Agarwal
Department of Internal Medicine, PGIMER, Chandigarh, 160012, India.
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Bhalla
Department of Internal Medicine, PGIMER, Chandigarh, 160012, India.
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Sharma
Department of General Surgery, PGIMER, Chandigarh, 160012, India.
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Singh
Data Center, PGIMER, Chandigarh, 160012, India.
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Sharma
Data Center, PGIMER, Chandigarh, 160012, India.
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Bahadur
Department of Anaesthesia, PGIMER, Chandigarh, 160012, India.
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Yadanapudi
Department of General Surgery, PGIMER, Chandigarh, 160012, India.
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Gupta
Department of General Surgery, PGIMER, Chandigarh, 160012, India.
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Singh
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003906:Developing Countries; D004363:Drug Utilization / Q000706:statistics & numerical data*; D017723:Drug Utilization Review / Q000379:methods*; D006779:Hospitals, Public; D006801:Humans; D007194:India; D008962:Models, Theoretical; D011446:Prospective Studies; D062606:Tertiary Care Centers
D000890:Anti-Infective Agents
Antibiotic stewardship; Defined daily dose; Developing country; Electronic record; System; Tertiary care