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Abstract 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.

Background: Catheter Associated Urinary Tract Infections (CAUTI) contribute 30%-40% of all the nosocomial infections and they are associated with substantially increased institutional death rates. A multimodal supervision program which incorporates training of the staff with respect to infection control measures can be effective in reducing the CAUTIs in hospitals. Aim: To assess the impact of a multimodal UTI supervision program on the CAUTI rates over a year, from January 2009 to December 2009, in a tertiary care hospital in India. Setting: A 215 bedded tertiary care private hospital. Materials and Methods: The CAUTI rates were analyzed for the first 6 months (January 2009-June 2009). A UTI supervision program was instituted in the month of July 2009, which included training with respect to the standard protocols for the sample collection and diagnosis, the bundle components of the urinary catheter checklist and hand hygiene practices. The impact was assessed as per the CAUTI rates in the subsequent months. Results: The average CAUTI rate was reduced by 47.1% (from 10.6 to 5.6) after the introduction of the supervision program This study presented the mean age of the patients with CAUTIs as 54.5 years and it showed an approximately equal contribution of both the sexes (52.94% in males and 47.05% in females). The impact analysis of the supervision program showed a reduction of 8.7% (from 23 days to 21 days) during the average duration of the catheterization. The adherence to the components of the urinary catheter check list was increased by 44.4% (p=0.069) and the hand hygiene compliance was increased by 56.4% (p=0.004) respectively after the interventions. Components like bladder irrigation and practising perineal cleaning were found to show no effect on the CAUTI rates. Conclusion: The most common labour and cost effective infection control measures as revealed by the supervision programme were adherence to the urinary catheter checklist components (indication for catheter insertion and change, asepsis maintenance during and after the catheter insertion and avoiding urine reflux) and hand hygiene practices, whereas bladder irrigation and practising perineal cleaning thrice a day were unnecessary measures. [ABSTRACT FROM AUTHOR]

Objectives: To carry out a retrospective study on Acinetobacter baumannii isolates from various clinical samples in a tertiary care hospital in India and analyze its epidemiology, antibiotic susceptibility patterns, pathogenic potential and nosocomial status. Materials and methods: The clinical specimens over a period of 14 months from December 2008 to January 2010 were analyzed and the A.baumannii isolates obtained by an automated identification system (Vitek 2 Compact) were segregated for further study. Their antibiograms were studied and a clinical correlation was made to assess their pathogenic status and mode of acquisition. Further, the nosocomial infections acquired during this period were studied and the contribution made by A.baumannii was calculated to assess its nosocomial status. Results: A.baumannii was isolated in 155 samples out of 1632 gram negative isolates (9.4% prevalence) from the entire hospital. Maximum isolates were from respiratory secretions (57.4%) followed by blood (23.8%). Prevalence of A.baumannii rose to 22.7% (119 out of 525) in intensive care unit (ICU) and 65 isolates (54.6%) proved to be pathogenic. A.baumannii contributed to 30.4% ventilator associated pneumonia, 35.2% Catheter Associated Blood Stream Infections, 12.5% Surgical Site Infections and 2.94% Catheter Associated Urinary Tract Infections. Overall resistance of A.baumannii towards carbapenems was 90% from all hospital isolates. ICU isolates showed higher resistance (93.2%) as compared to Inpatient Department (82.7%) and Out-patient Department (57.1%). Conclusion: In this study, A.baumannii isolates showed a pathogenic potential of around 54.6% and a majority were found to be carbapenem resistant. We must be cognizant of the fact that all A.baumannii isolations doesn't necessarily mean infection and antibiotics should only be given in clinically proven infections. [ABSTRACT FROM AUTHOR]