Antimicrobial Stewardship and Its Impact on the Changing Epidemiology of Polymyxin Use in a South Indian Healthcare Setting.

Dipu T Sathyapalan ,Nandita Shashindran,Merlin Moni,Jini James,Vrinda Nampoothiri,Sangita Sudhir,Preetha Prasanna,Fabia Edathadathil,Zubair Umer Mohamed ,Sanjeev Singh ,Praveena Bhaskaran ,Jisha Thomas

doi:10.3390/antibiotics10050470

Abstract

Polymyxins being last resort drugs to treat infections triggered by multidrug-resistant pathogens necessitates the implementation of antimicrobial stewardship program (ASP) initiatives to support its rational prescription across healthcare settings. Our study aims to describe the change in the epidemiology of polymyxins and patient outcomes following the implementation of ASP at our institution. The antimicrobial stewardship program initiated in February 2016 at our 1300 bed tertiary care center involved post-prescriptive audits tracking polymyxin consumption and evaluating prescription appropriateness in terms of the right indication, right frequency, right drug, right duration of therapy and administration of the right loading dose (LD) and maintenance dose (MD). Among the 2442 polymyxin prescriptions tracked over the entire study period ranging from February 2016 to January 2020, the number of prescriptions dropped from 772 prescriptions in the pre-implementation period to an average of 417 per year during the post-implementation period, recording a 45% reduction. The quarterly patient survival rates had a significant positive correlation with the quarterly prescription appropriateness rates (r = 0.4774, p = 0.02), right loading dose (r = 0.5228, p = 0.015) and right duration (r = 0.4361, p = 0.04). Our study on the epidemiology of polymyxin use demonstrated favorable effects on the appropriateness of prescriptions and mortality benefits after successful implementation of antimicrobial stewardship in a real-world setting.

Highlights

IntroductionThe prevalence of healthcare-associated infections (HAIs) caused by antibiotic-resistant, gram-negative organisms, including extended spectrum β-lactamase-producing and carbapenem-resistant Enterobacterales, multidrug-resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa, is increasing worldwide and represents a major public health threat [1,2,3]
A global review of antibiotic consumption revealed that antibiotic utilization increased by 36% over a 10 year period (2000–2010), with the most notable escalation reflected in the carbapenem and polymyxin classes [19]
This trend correlates with the mounting rates of MDR and XDR gram-negative pathogens and mirrors the need to parallelly rationalize the use of polymyxins through strategies like antimicrobial stewardship to prevent the emergence of polymyxin resistance and ensure an optimum clinical cure

Summary

Introduction

The prevalence of healthcare-associated infections (HAIs) caused by antibiotic-resistant, gram-negative organisms, including extended spectrum β-lactamase-producing and carbapenem-resistant Enterobacterales, multidrug-resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa, is increasing worldwide and represents a major public health threat [1,2,3]. The brunt of MDR gramnegative infections is high in the Indian setting, which could be attributed to widespread inappropriate antimicrobial prescriptions used in the treatment of gram-negative infections [4,5]. Widespread inappropriate prescriptions in usual drug resistance (UDR) and non-standardized dosing regimens will foster a risk of resistance. Optimum utilization of such antimicrobials that are possibly active against multidrug and extremely drug resistant (MDR and XDR) bacteria is warranted

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