PMU3 EFFECTIVENESS OF IMPLEMENTATION OF ANTIMICROBIAL STEWARDSHIP PROGRAMMES IN INDIA: EVIDENCE FROM SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Antimicrobial stewardship programmes (ASPs) aims to optimize antibiotic use and minimize antimicrobial resistance. From 2017 to 2021, India is implementing the National Action Plan on Antimicrobial Resistance to combat AMR and improve antibiotic use. The use of ASPs is increasing in developing countries like India, but their effectiveness in antibiotic consumption and their impact on clinical outcomes is not clear. The objective of the study is to assess the efficacy of ASPs and quality of ASPs conducted in India by using systematic review and meta-analyses. Electronic databases Pubmed, Embase and Google scholar were searched from inception to September 2019 for studies evaluating any ASPs in the community or hospital setting, without restriction on study design or outcome. Efficacy outcome like defined daily dose, length of stay, risk of mortality, improvement in rational use of Antimicrobials were used to assess the effectiveness of ASPs. Random effects models was used to pool the studies. 11 studies, which evaluated the ASPs on N= 5484 subjects were included in this systematic review and five studies were conducted at private setting and remaining studies were at private tertiary care clinics. Among the included studies, following key strategies were used as ASPs: Prospective audit with feedback (n =4), formulary restriction (n =3), preauthorization (n =3), and guidelines (n =1). After implementation of ASPs, clinic outcomes defined daily dose (mean difference (MD); -11.64 (95% CI: -42.22 to 18.93) and length of stay (MD; 0.08 (95% CI -2.51 to 2.6) were reduced significantly. The pooled relative risk of mortality rate was 0.88 (95% CI = 0.77–1.001). The findings of this systematic review concludes that, Even though implementations of ASPs improved clinical outcomes, there was huge variation in the implementations ASPs in hospital and clinic settings in India. Hence we need proper guidelines in implementation of the ASPs.