{
  "abstract": "Background ICUs 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. Methods A 17-month retrospective observational study was conducted, comparing an eight-month pre-implementation 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 time-series (ITS) regression. Results Across 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). Conclusion The 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.",
  "abstract_shown": true,
  "affiliations": [
    "Microbiology, NRI Medical College and General Hospital, Guntur, IND.",
    "Microbiology, Saveetha Medical College and Hospital, Chennai, IND.",
    "Centre for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Naseema Shaik"
    },
    {
      "affs": [
        1
      ],
      "name": "Susmitha Simgamsetty"
    },
    {
      "affs": [
        0
      ],
      "name": "Padmaja Yarlagadda"
    },
    {
      "affs": [
        0
      ],
      "name": "Uma Penmethsa"
    },
    {
      "affs": [
        2
      ],
      "name": "Mukesh Kumar Dharmalingam Jothinathan"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5cdsg9sw9as19.bib",
  "cited_by": 0,
  "doi": "10.7759/cureus.117062",
  "fulltext_url": "https://europepmc.org/articles/PMC13714860",
  "id": "5cdsg9sw9as19",
  "issns": [
    "2168-8184"
  ],
  "landing_url": "https://europepmc.org/article/MED/42953638",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Infectious Disease"
    ],
    [
      "openalex",
      "2402|Antibiotic Use and Resistance"
    ]
  ],
  "openalex": "W7214672649",
  "pdf_url": "https://europepmc.org/articles/PMC13714860?pdf=render",
  "pmcid": "PMC13714860",
  "pmid": "42953638",
  "published": "2026-09-28",
  "publisher": "Cureus Inc.",
  "ris": "https://research.draconitic.com/paper/5cdsg9sw9as19.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:41Z",
      "native_id": "MED:42953638",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42953638"
    },
    {
      "first_seen": "2026-11-01T12:22:16Z",
      "native_id": "PMC13714860",
      "source": "pmc",
      "url": "https://doi.org/10.7759/cureus.117062"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "heading:Infectious Disease",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Multidisciplinary Antimicrobial Stewardship Program in an Indian ICU: A Time-Series Analysis of Diagnostic Practices and Antibiotic Use.",
  "title_text": "Multidisciplinary Antimicrobial Stewardship Program in an Indian ICU: A Time-Series Analysis of Diagnostic Practices and Antibiotic Use.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:22:16Z",
  "url": "https://research.draconitic.com/paper/5cdsg9sw9as19",
  "venue": "Cureus",
  "versions": []
}