Antimicrobial Stewardship Programs in India

The world population is growing fast, and India is touted to hit a population of 1.7 billion people by 2050 [1]. With such rapid population growth, the Indian population is more susceptible to infectious diseases than ever before. The role of antibiotics in disease control is ever-so-important now, and hence, it’s crucial to understand the right practices when prescribing antibiotics, the ‘6 Rs’ – right dosage, right frequency, right route, right duration, right choice and right diagnosis – which is the core foundation of antimicrobial stewardship (AMS) teams. When prescribing antibiotics, doctors focus on positive clinical outcomes, as they rightly should, but the effect of antimicrobial resistance (AMR) often gets overlooked.

The absence of AMS teams or the lack of effective guidelines for existing AMS teams in hospitals and medical institutes hinders effective antibiotic therapy. A lackadaisical approach to antibiotic prescriptions (specifically overprescribing) can enable certain microorganisms to grow antibiotic resistance, rendering those antibiotics useless. According to The Telegraph, In India, a multi-drug resistant strain of the common bacteria Klebsiella, which can cause lung, urinary tract and abdominal infections, has already infected 31% of the patients undergoing treatment for sepsis. The study continues on, however, there are only a very small set of institutions that are able to help, the medical college in question, out. [3] A lot of times, prescribing antibiotics will not only kill the harmful bacteria but also take down important bacteria necessary for body functioning, along with them. This is a more immediately noticeable effect of overuse of antibiotics, and are called CDIs or Clostridium Defficile Infections, which are infections caused due to a killing of the necessary bacteria present in the human gut.

AMS In India

In India, there is no official body involved to supervise and standardise AMS programs, and AMS teams are formed at the discretion of the hospital or medical institution. There is also a deep-rooted fragmentation of prescription guidelines, let alone antibiotic prescriptions. Hence, creating a greater danger of running out of effective antibiotics. Nevertheless, we see a growing initiative taken by the Indian government in the form of The 2011 Jaipur Declaration[4], The 2013 Chennai Declaration[5] and the NCDCs National Treatment Guidelines for Antimicrobial Use in Infectious Diseases[6]. These programs help shed more light to AMR while enlightening active practitioners, medical students and the public of the dangers of poor antibiotic therapy and further formalising a set of guidelines for hospitals and medical institutions to follow. Awareness and the right mentality toward AMR and antibiotic prescription cultivated at a learning age can only better the state of antibiotic prescriptions and efforts put into controlling antimicrobial resistance and antimicrobial stewardship.

We wanted to understand how AMS programs functioned in India, so we headed over to various medical institutes, like AIIMS (All India Institute of Medical Sciences), Rishikesh and JIPMER (Jawaharlal Institute of Postgraduate Medical Education & Research), Tamil Nadu, taking interviews and performing surveys alongside attending relevant conferences.

The AMS Programs’ Process

The research conducted allowed us to create a generalised overview of how various AMS programs work, across various institutions.

1. Each member of the AMS team spends approximately 3 hours a day collecting inpatient data from their allocated ward.
2. At the end of every week, the team conducts a meeting to manually analyse all the data collected.
3. At the end of the month, they share their insights with the respective clinicians to get a better idea of the state of antibiotic therapy at the hospital.  

Our take

The Downsides

• Manual Data Collection and Analysis:
  Numerous hours went by collecting data and digging around to find relevant information and insights from this data, especially so since these processes happened using pen and paper.  
• Disjoint Process:
  The programs’ processes, are not connected and consistent across all the institutions. This can create fragmentation and incongruence in the data output.
• Data Collected from Limited Wards:
  The team collected inpatient data from a limited set of wards because of the tremendous amount of time taken in doing so.
• Reactive not Proactive: 
  Due to the immense amount of time consumed in this process, the AMS programs tend to be reactive, not proactive. AMS programs need, not only to be able to respond to the threat of AMR but also, to control the problem before it amplifies.
• Fixed time updates:
  Sharing insights at the end of the month leads to a possibility of the shared information becoming irrelevant, setting a dangerous precedent to the future of antibiotic therapy at the hospital.

The Positives

The practitioners, professors and students involved showed genuine interest towards AMS and AMR. Having no affiliation with any official body, the efforts put in by the AMS teams are recognisable and commendable.

The Scope of Digitising AMS

After talking to the doctors and consultants involved in the AMS program, our research indicated that 93% of them agreed with the idea of a software tool to monitor infections, perform antibiotic-usage data analysis and antibiotic prediction would benefit the AMS and Infectious Diseases teams greatly. The lack of technological inclusions in AMS programs can set AMS teams back significant amounts of time and resources. We immediately saw that there is a massive scope for software tools to aid AMS teams.

ZEVAC™ and Antimicrobial Stewardship

ZEVAC™ is an AI/ML powered antimicrobial stewardship tool conceived out of our desire to aid AMS teams around the world. Using inpatient data and proprietary AI/ML algorithms, ZEVAC™ performs real-time antimicrobial susceptibility analysis controlled by the guidelines set up by the hospital, providing rapid, consistent, seamless and personalised data analysis. Besides this, ZEVAC™ also forms hospital-level stratified antibiograms to optimise resource requirement for effective antibiotic therapy.

However, we believe there is a massive scope in expanding ZEVAC to further better antibiotic therapy in hospitals. We are hard at work to identify and realise specific product features that will serve to enhance the user experience in our pursuit of a comprehensive AMS tool. Here are some of the exciting features that are currently under works –

• AI-generate Culture Reports
• Early Prediction of HAI (Hospital-Acquired Infection) Incidents

If you are interested in adopting ZEVAC™ and joining the CoL family or would like to know anything more, feel free to reach out to us at hello@mycol.in!