Control of multidrug resistant bacteria in a tertiary care hospital in India

Background: The objective of this study was to assess the impact of antimicrobial stewardship programs on the multidrug resistance patterns of bacterial isolates. The study comprised an initial retrospective analysis of multidrug resistance in bacterial isolates for one year (July 2007-June 2008) followed by prospective evaluation of the impact of Antimicrobial Stewardship programs on resistance for two years and nine months (July 2008-March 2011). Setting: A 300-bed tertiary care private hospital in Gurgaon, Haryana (India) Findings: Methods: Study Design July 2007 to June 2008: Resistance patterns of bacterial isolates were studied. July 2008: Phase I intervention programme Implementation of an antibiotic policy in the hospital. July 2008 to June 2010: Assessment of the impact of the Phase I intervention programme. July 2010 to March 2011: Phase II intervention programme: Formation and effective functioning of the antimicrobial stewardship committee. Statistical correlation of the Defined daily dose (DDD) for prescribed drugs with the antimicrobial resistance of Gram negatives. Results: Phase I intervention programme (July 2008) resulted in a decrease of 4.47% in ESBLs (E. coli and Klebsiella) and a significant decrease of 40.8% in carbapenem-resistant Pseudomonas. Phase II intervention (July 2010) brought a significant reduction (24.7%) in carbapenem-resistant Pseudomonas. However, the resistance in the other Gram negatives (E. coli, Klebsiella, and Acinetobacter) rose and then stabilized. A positive correlation was observed in Pseudomonas and Acinetobacter with carbapenems and cefoperazone-sulbactam. Piperacillin-tazobactam showed a positive correlation with Acinetobacter only. E. coli and Klebsiella showed positive correlation with cefoparazone-sulbactam and piperacillin-tazobactam. Conclusion: An antimicrobial stewardship programme with sustained and multifaceted efforts is essential to promote the judicious use of antibiotics.