A Prospective Interventional Study of Antimicrobial Audit Before and After Implementing Antimicrobial Stewardship Program in the Intensive Care Unit of A Medical College Hospital

Background: Inappropriate antibiotic prescribing in Intensive Care Units (ICUs) contributes significantly to antimicrobial resistance (AMR), prolonged hospitalization, increased healthcare costs, and poor clinical outcomes. Antimicrobial Stewardship Programs (AMSPs) have been developed to promote the rational use of antibiotics through evidence-based prescribing, regular audits, and clinician feedback. This study evaluated the impact of implementing an AMSP on antibiotic prescribing practices in the ICU of a tertiary care teaching hospital. Material and Methods: A prospective interventional study was conducted over six months among 100 ICU patients receiving systemic antibiotics (50 pre-intervention and 50 post-intervention). An Antimicrobial Stewardship Program comprising clinician education, institutional antibiotic guidelines, antibiogram-based prescribing, and prospective audit with feedback was implemented. The primary outcome was the appropriateness of antibiotic prescribing, while secondary outcomes included guideline compliance, documentation practices, antibiotic consumption, culture-guided therapy, de-escalation, intravenous-to-oral conversion, duration of therapy, and clinical outcomes. Results: Appropriate antibiotic prescribing improved significantly from 56.0% before intervention to 72.0% after implementation (p=0.048). Compliance with institutional antibiotic guidelines increased from 58.0% to 72.0% (p=0.041). Documentation of antibiotic indication improved from 60.0% to 78.0%, review date documentation from 42.0% to 68.0%, and collection of cultures before antibiotic initiation from 46.0% to 62.0% (all p<0.05). Mean antibiotic consumption, measured by Defined Daily Dose, decreased from 90.2 ± 15.1 to 78.6 ± 13.8 DDD/100 patient-days (p=0.012). Days of Therapy and Length of Therapy were also significantly reduced, while antibiotic de-escalation increased from 20.0% to 38.0% (p=0.047). The duration of antibiotic therapy decreased significantly, ICU length of stay showed a modest reduction, and mortality remained comparable between the two groups. Conclusion: Implementation of an Antimicrobial Stewardship Program led to a moderate but significant improvement in antibiotic prescribing, guideline compliance, documentation, and rational antimicrobial use, while reducing antibiotic consumption without compromising patient safety.

Keywords: Antimicrobial Stewardship Program, Antibiotic Audit, Antimicrobial Resistance, Intensive Care Unit, Rational Antibiotic Prescribing.