Background and Objectives: Inappropriate antimicrobial use has rapidly become a global concern leading to increased antimicrobial resistance. Antibiotic resistant organisms are not only becoming increasingly difficult to treat but also lead to increased treatment costs, longer duration of hospital stay and in some cases even death; over 30% of deaths have been attributed to antimicrobial resistance (AMR). In setting of ICU, AMR has been shown to be associated with increased ICU mortality, complications and cost of treatment which can be a huge burden for emerging economies. We therefore decided to conduct this before and after study to test the feasibility of a clinical protocol based ASP with respect to pattern of HCAI, acquisition of resistance and mortality.

Methods:  This study was a prospective before and after study design which was divided into 3 phases over a span of 12 months. A pre- implementation audit (phase 1) was conducted for 1^st 3 months studying various prescription practices that were being followed in ICU and general observation. Antimicrobial stewardship was implemented in phase 2 for a period of 6 months. After the implementation of ASP in PICU, a similar audit on antimicrobial prescription and usage was done in next three months (phase 3) and the results compared with the audit of pre-implementation period.

Results: Our study was designed to note effect of antimicrobial stewardship on HCAI outcomes, cost, complications and mortality patterns in Pediatric ICU. Our findings revealed that there was a statistically significant reduction in health care associated infections (HCAI) from 24.2% in pre implementation (phase1) to 3.2% following implementation of ASP with statistically significant p value of 0.001, similar difference in cost of antimicrobials was also noted in both phases. Adverse drug reaction needing to stop the drug were 7% in phase 1 which statistically reduced to 1% following implementation of ASP. However we were not able to find any statistically significant change in mortality pattern between pre and post ASP implementation phases.

Keywords: antimicrobial stewardship (AMS), antimicrobial resistance (AMR) , multi drug resistant (MDR), health care associated infections (HCAI).

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Dr Arnav Shandil, MD

Civil Hospital Theog, Shimla H.P, India