Use of a regression model and a statistical process control method to assess AWaRe classification-based antimicrobial consumption in an Indian tertiary care hospital over 5 years

Abstract

Introduction: The World Health Organization (WHO) recommends quality-based “AWaRe classification of antibiotics” for the monitoring of antimicrobial consumption. It classifies commonly used antimicrobials into five main categories: Access, Watch, Reserve, Not-recommended (NR), and Others. At least 60% of total consumption should be from the Access category and <10% should be from the Reserve category to minimize the further development of resistance. However, we do not know how these recommendations compare with current trends in antimicrobial consumption in India. Hence, a study was planned to statistically evaluate the AWaRe classification-based trend of antimicrobial consumption over 5 years. Materials and Methods: A retrospective study was conducted to retrieve the antimicrobial consumption data of SMS Hospital, Jaipur, from January 2017 to December 2021 as per AWaRe classification. Regression and statistical process control analysis was carried out separately for all five categories of antimicrobials on MATLAB 2016a (9.0.0.341360). Results: Regression analysis revealed that the consumption of Access, NR, and Others significantly decreased while that of Watch and Reserve increased between 2017 and 2021. Statistical process control analysis showed that the use of Access, Watch, and Others was within prescribed statistical limits but that of Reserve and NR was higher than statistical thresholds at times. Conclusion: The increased consumption of Watch and Reserve antimicrobials combined with surpassing of upper control limit by Reserve and NR antimicrobials at certain times raises concern. Hence, there is an acute need to take measures to generate awareness about the incorporation of the WHO recommendations in practice to support the antimicrobial stewardship program. The core competencies addressed in this article are: Medical knowledge, Systems-based practice, Practice-based learning and improvement, Professionalism.