Multidisciplinary Antimicrobial Stewardship Program in an Indian ICU: A Time-Series Analysis of Diagnostic Practices and Antibiotic Use
Year: 2026
Type: article
Abstract: BackgroundICUs are high-risk environments for antimicrobial resistance (AMR).We evaluated the impact of a multidisciplinary Antimicrobial Stewardship Program (AMSP) on diagnostic stewardship, prescribing patterns, and antimicrobial consumption in an Indian tertiary critical care setting. MethodsA 17-month retrospective observational study was conducted, comparing an eight-month preimplementation phase (January-August 2024) with a nine-month post-implementation phase (September 2024-May 2025).The AMSP included staff training, structured prescription orders, prospective audits, and monthly feedback.Key metrics included pre-antibiotic culture collection, institutional guideline adherence, surgical antimicrobial prophylaxis (SAP) compliance, and standardized consumption densities (defined daily dose (DDD)/100 bed-days and days of therapy (DOT)/1,000 bed-days), evaluated using interrupted timeseries (ITS) regression. ResultsAcross 7,682 ICU admissions (3,514 pre-vs.4,168 post-implementation), pre-antibiotic culture collection increased significantly: blood cultures increased from 331 (20.2%) to 560 (45.8%; p < 0.001), and urine cultures increased from 1,365 (53.0%) to 1,583 (64.6%; p < 0.001).Empirical guideline adherence improved from 1,618 (46.0%) to 3,005 (72.1%; p < 0.001), and SAP compliance increased from 1,352 (35.5%) to 2,083 (63.2%; p < 0.001).Total antimicrobial consumption density decreased by 44.0% (120.04 to 67.17 DDD/100 bed-days; p < 0.001), and duration density declined by 39.6% (981.23 to 592.91 DOT/1,000 bed-days; p < 0.001; ITS regression step-reduction p < 0.001).Meropenem exposure remained strictly controlled and stable (165 (4.7%) vs. 208 (5.0%); p = 0.549). ConclusionThe multidisciplinary AMSP successfully contained overall antibiotic selection pressure while preserving carbapenems through optimized beta-lactam/beta-lactamase inhibitor utilization.Microbial ecology remained stable, with Klebsiella spp.and Escherichia coli predominating.Unadjusted case-mix differences represent a recognized study limitation.Implementing a multidisciplinary AMSP achieved sustained reductions in antimicrobial consumption and improved diagnostic practices, providing a feasible framework to combat resistance in resource-limited ICUs.
Source: Cureus
Institutions: Guntur Medical College, NRI Medical College, Saveetha University
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7214672649