Multidisciplinary Antimicrobial Stewardship Program in an Indian ICU: A Time-Series Analysis of Diagnostic Practices and Antibiotic Use.
- 1Microbiology, NRI Medical College and General Hospital, Guntur, IND.
- 2Microbiology, Saveetha Medical College and Hospital, Chennai, IND.
- 3Centre for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND.
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.
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BibTeX
@article{shaik2026multidisciplinary,
title = {{Multidisciplinary Antimicrobial Stewardship Program in an Indian ICU: A Time-Series Analysis of Diagnostic Practices and Antibiotic Use.}},
author = {Naseema Shaik and Susmitha Simgamsetty and Padmaja Yarlagadda and Uma Penmethsa and Mukesh Kumar Dharmalingam Jothinathan},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117062},
url = {https://europepmc.org/article/MED/42953638},
note = {CC BY},
}
RIS
TY - JOUR
TI - Multidisciplinary Antimicrobial Stewardship Program in an Indian ICU: A Time-Series Analysis of Diagnostic Practices and Antibiotic Use.
AU - Naseema Shaik
AU - Susmitha Simgamsetty
AU - Padmaja Yarlagadda
AU - Uma Penmethsa
AU - Mukesh Kumar Dharmalingam Jothinathan
PY - 2026
DA - 2026/09/28
JO - Cureus
DO - 10.7759/cureus.117062
UR - https://europepmc.org/article/MED/42953638
AB - 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.
SN - 2168-8184
ER -