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Year : 2016  |  Volume : 34  |  Issue : 1  |  Page : 3--4

Antimicrobial consumption in hospitals of developing nations: When will the Gap Bridge between infection rates and prescription patterns?

P Mathur 
 Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
P Mathur
Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi

How to cite this article:
Mathur P. Antimicrobial consumption in hospitals of developing nations: When will the Gap Bridge between infection rates and prescription patterns?.Indian J Med Microbiol 2016;34:3-4

How to cite this URL:
Mathur P. Antimicrobial consumption in hospitals of developing nations: When will the Gap Bridge between infection rates and prescription patterns?. Indian J Med Microbiol [serial online] 2016 [cited 2020 Oct 24 ];34:3-4
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Antimicrobial resistance is an established and ever-increasing global threat, compounded by the dissemination of Klebsiella pneumoniae carbapenemase and New Delhi metallo-β-lactamase mediated resistance.

In most developed countries, prevention of HCAIs has been a staged approach, beginning with establishing a proper surveillance, followed by implementation of preventive bundles and an antimicrobial stewardship programme.

By contrast, in developing countries, surveillance, implementation of preventive bundles and establishment of antimicrobial stewardship programmes are in a very nascent stage. Antimicrobial consumption patterns are often taken as benchmarks for assessing such preventive programmes in the developed world. In the absence of regulations, in developing nations, antimicrobial prescription remains a matter of personal preference; stewardship programmes being a seemingly distant goal. An objective parameter for assessing the outcome of infection control programme in these nations remain the rates of device associated infections (DAIs) and surgical site infections (SSI), diagnosed on the basis of standard definitions and the measurement of compliance rates to preventive care bundles.[1]

We had a very high rate of DAIs as recent as 2010.[2] In view of this, we initiated a comprehensive surveillance for HCAIs at our level-1 Trauma Center of AIIMS hospital since 2010.[3] The surveillance was based on standard definitions for DAIs. An indigenous software for surveillance was developed, along with an intensive on-going programme of training, reporting, and feedbacks.[3] Data were analysed to see if the rates of DAIs correspond with the antimicrobial consumption at our centre.

We observed that over the three subsequent years, there was a marked reduction in the rates of all DAIs and SSIs, along with an increase in the compliance to hand hygiene and preventive care bundles [Table 1].[2] However, the antimicrobial consumption pattern seemed completely unaffected by these declining rates of infections [Table 1]. The antimicrobial cost per patient actually increased during this time. An explanation for this could be the increased use and dosage of colistin for suspected cases of ventilator-associated pneumonia (VAP)/sepsis, since multidrug-resistant Acinetobacter spp. are the most common pathogens in our hospital. An aggressive antimicrobial treatment approach to salvage young trauma victims progressing into sepsis may be another reason, as also the large bulk of patients suspected of having “bad abdominal wounds.” These are cases where cultures usually grow a polymicrobial flora, and therefore, high generation antimicrobials are given empirically.{Table 1}

There is a dire need to protocolise and implement antimicrobial stewardship programmes in our system and other developing nations. We need a policy that can be implemented and regulated.[4] Otherwise, as the infection control programmes will become more efficient, the disparity between the objective observation of rates of HCAIs and antimicrobial consumption will continue to grow and be difficult to explain, only if we succeed in demonstrating a drop in antimicrobial consumption, our infection control programmes can be deemed to be successful. This will require a conscious effort to reduce personal preference- and assumption-based antimicrobial administration and sticking to protocols. Such an approach should ideally begin with teaching and tertiary referral centres, gradually percolating to the peripheral centres. However, it is not an easy road, considering the highly variable administrative, sociocultural, educational and regulatory systems operating at different health care sectors of our nation.

Not everything is, however, grim. On the positive side, the Government is taking many affirmative actions to curb over-the counter sale of high generation antimicrobials and other measures to restrict indiscriminate antimicrobial usage.[5] Taskforce is being set up, and efforts are being made to build National registries and guidelines for an antimicrobial prescription.

The effectiveness of these measures in the populous developing nations will ultimately impact the global epidemiology of multidrug resistance and antimicrobial consumption.


The software for surveillance of HCAIs was developed through a grant from the Indian Council of Medical Research.


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2Gunjiyal J, Thomas SM, Gupta AK, Sharma BS, Mathur P, Gupta B, et al. Device-associated and multidrug-resistant infections in critically ill trauma patients: Towards development of automated surveillance in developing countries. J Hosp Infect 2011;77:176-7.
3Mathur P, Tak V, Gunjiyal J, Nair SA, Lalwani S, Kumar S, et al. Device-associated infections at a level-1 trauma centre of a developing nation: Impact of automated surveillance, training and feedbacks. Indian J Med Microbiol 2015;33:51-62.
4Kapil A. India needs an implementable antibiotic policy. Indian J Med Microbiol 2013;31:111-3.
5Ghafur A. Chennai declaration: An initiative our country could be proud of! Indian J Med Microbiol 2014;32:1-2.