A multicentre point prevalence survey (PPS) of antimicrobial use amongst
admitted patients in tertiary care centres in India
Authors: Panditrao Aditi M , Shafiq Nusrat , Chatterjee Suparna , Pathak Ashish , Trivedi Niyati , Sadasivam Balakrishnan , Kshirsagar Nilima , Kaul Rajni , Biswal Manisha , Kakkar Ashish , Malhotra Samir , Arora Pankaj , Talati Shweta , Dhaliwal Navneet , Hazra Avijit , Jhaj Ratinder , Najmi Ahmad , Pandey Navin , Chakraverty Raja , Pathan Saman , Chauhan Janki , Mathur Aditya ,   the ASPIRE (‘Antimicrobial Stewardship Programme In Resource-limited Environment’) Study Group, Sekhon Amritpal , Sarao Anurag , Haider Aqeel , Pandey Avaneesh
                    Kumar , Mothsara Chakrant , Chandrahasan K , Harish Kumar C V
                    N , Belavigi Devaraj , Arora Geetika , Vishwas Gopal , Kaur Harinder , Kaur Harpreet , Rather Imran Ibni
                    Gani , Kaur Kulbeer , Kumaravel Janagiraman , Murali Naveen , Jain Manav , Gamad Nanda , Kumar-M Praveen , Sharma Priyanka , Rohilla Rachna , Bhandari Ritika
                    Kondel , Maini Rupinder , Rajpoot Surria , Kaushik Varnit , Mahalmani Vidya , Samanta Kalyan , Choudhury Poulami
                    Roy , Chakraborty Dolon , Ghosh Abhijnan , Thakurta Priyanka
                    Guha , Nath Rohit
                Kumar , Thakur Sayanto , Kar Bikashkali , Pattanayak Abir , Banerjee Souryadip , Roy Ritam , Chatterjee Sayan , Dingal Niladri
                    Sekhar , Singh Pooja , Das Aditi , Ray Avik , Gupta Ayush , Dangi Mahendra , Nanda Malaya , Patidar Ritendra , Sharma Swati , Praveen C
                  A , Singh Sakshi , Gautam Meena , Jaiswal Shruti , Santenna C , Kumar Sunil , Yadav Sanjeev , Shrivastav Arti , Patel Kandarp , Hirani Shilpa , Suthar Badal , Patel Suchi , Banerjee Sushmita , Modi Dhruv , Naik Dhara , Dewan Nilesh , Patel Krishna , Kansara Monang 
Published: December 2020

Abstract

Objectives
Data from point prevalence surveys (PPSs) in India are scarce. Conducting PPSs is especially challenging in the absence of electronic medical records, a lack of dedicated resources and a high patient load in resource-poor settings. This multicentre survey was conducted to provide background data for planning and strengthening antimicrobial stewardship programmes across the country.

Methods
This inpatient PPS was conducted over 2 weeks in May 2019 simultaneously across five study centres in India. Data about patient characteristics, indications for antimicrobials use and details of each antimicrobial prescribed including supportive investigation reports were collected in predesigned forms.

Results
A total of 3473 admitted patients in wards and ICUs were covered across five study centres. Of these, 1747 (50.3%) patients were on antimicrobials, with 46.9% patients being on two or more antimicrobials. Out of the total antimicrobials prescribed, 40.2% of the antimicrobials were prescribed for community-acquired infection requiring hospitalization followed by surgical prophylaxis (32.6%). Third-generation cephalosporins and drugs from the ‘Watch’ category were prescribed most commonly. Only 22.8% of the antimicrobials were based on microbiology reports.

Conclusions
The survey demonstrated a high use of antimicrobials in admitted patients with a considerable proportion of drugs from the ‘Watch’ category. The targets for interventions that emerged from the survey were: improving surgical prophylaxis, decreasing double anaerobic cover, initiating culture of sending cultures and de-escalation with targeted therapy.