1. Integrated Antimicrobial Stewardship (IAS) Practice Statements for Indian Hospitals
Considering the importance of integrated antimicrobial stewardship (IAS) practices by each hospital and each healthcare worker (HCW), it is vital to have a practice statement from SASPI based on available evidence from the literature and a recently completed Delphi study under SASPI. This document is developed and finalized through a Delphi model where it was prepared by three Indian experts (An ID physician, A Pharmacologist and A Microbiologist) in the first phase, and shared with SASPI members with experts in the same field (at least one expert (HICC/AMSP member) from 31 tertiary care institutes/hospitals) for content validation and comments regarding the feasibility of their practices in the second phase, and lastly again verified by same three experts of the first phase and prepared the practice statements with consideration of all relevant comments by individual institute experts in third phase. These practice statements (Box 1) are the baseline Indian practice guidance towards IAS practices to curtail AMR in tertiary care hospitals. Each Indian hospital is advocated to follow these practices. With time, through multi-centric participation under the banner of SASPI, these practices will be monitored and updated towards higher goals.2. Multicentric PPS 2025 Publication- ASPIRE II/ SASPI
Summary:
Participating Centers
The survey included eight prominent medical institutions: 1. AIIMS, BHOPAL 2.AIIMS, RISHIKESH 3.AIIMS, BATHINDA 4.AIIMS, JODHPUR 5.AIIMS, GORAKHPUR 6.AIIMS, RAEBARELI 7.GOVERNMENT MEDICAL COLLEGE, BARODA Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh served as Central Coordinating SiteMethodology
This cross-sectional survey was conducted over two weeks between May and August 2023 in eight Indian tertiary care hospitals. The survey comprised two parts: the ward form, which captured ward details (name, specialty, bed count, and antibiotic use), and the patient form, which documented demographics, antimicrobial therapy, and microbiological data, including redundant coverage and designated antibiotics. Rationality was assessed using 50 forms from each site. Data were collected digitally by trained team of surveyors. The study included hospitalized patients on systemic antimicrobials, excluding outpatient, day-care dialysis patients, and those on topical antibiotics.Findings
Among 3974 patients in eight hospitals, adult surgical and pediatric medical wards had the highest antibiotic usage. Of 4248 prescriptions, the most common antibiotics were ceftriaxone (14.9%, 95% CI: 10.4%, 18.4%), metronidazole (10.2%, 95% CI: 6.0%–11.2%), amikacin (8.7%, 95% CI: 6.3%–11.3%), piperacillin/tazobactam (8.7%, 95% CI: 9.1%–10.5%), and meropenem (7.1%, 95% CI: 5.2%–9.5%). Antibiotics were categorized as ‘Watch’ (57.03%), ‘Access’ (32.67%), and ‘Reserve’ (5.08%). Primary indications were community-acquired infections (30.6%, 95% CI: 25.1%–32.5%) and surgical prophylaxis (31%, 95% CI: 29.8%–36.9%). HAIs prevalence was 13.3% (95% CI: 9.3%–15.4%), with majority of use being empiric (48.96%, 95% CI: 35.1%–58.8%). Common isolates included Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus. Assessment of rationale of antibiotic use was assessor dependent and variable (0–50% irrational prescriptions, majority due to prolonged duration of prophylaxis/treatment) across sites.Interpretation
The SASPI (Society of Antimicrobial Stewardship Practices in India)-led survey underscores the high use of antibiotics in the included tertiary care centers emphasizing the need for point prevalence surveys to guide antimicrobial stewardship programs. It highlights the importance of ongoing AMR surveillance, improved stewardship, and education to refine prescribing practices, targeting hospital-acquired infections, and reducing unnecessary treatments.Coming Soon…..
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