ABSTRACT

Introduction: Antimicrobial Resistance (AMR) is a critical public health threat in India, worsened by overprescription, unregulated antibiotic access, and fragmented Antimicrobial Stewardship Program (AMSP) implementation. The Society of Antimicrobial Stewardship Practices India (SASPI) developed a 42-point Integrated AMS (IAS) practice statement in 2024 to standardize stewardship across institutions. This study assessed the current adoption of these practices across Indian tertiary-care hospitals.

Methods: A multicentric, cross-sectional, survey-based study was conducted under SASPI’s capacity-mapping initiative. A structured self-administered questionnaire based on the 42-point IAS statement, spanning four domains — Administrative, Diagnostic Stewardship, Infection Prevention and Control (IPC), and Antimicrobial Stewardship (AMS) — was distributed to SASPI-affiliated institutes presenting at ASPICON 2025. Implementation was rated on a 0–100% scale and categorized as High (≥75%), Moderate (50–74%), or Low (<50%).

Results: Of 150 invited institutes, 17 participated. The overall mean compliance across all 42 items was 66.32% ± 18%. Diagnostic stewardship showed the highest adherence (81.76% ± 11.93), followed by IPC (80.12% ± 13.59) and administrative practices (66.34% ± 19.96), while AMS-specific practices showed markedly low adherence (37.06% ± 28.11). Ten of twelve AMS practice points — including pre-authorization of restricted antimicrobials, OPAT policies, PK/PD documentation, and antimicrobial time-out practices — fell into the “low” implementation category. Institution-wise scores ranged from 48.02% to 97.46%, with 5 institutions scoring “high,” 9 “moderate,” and 3 “low.” Conclusion: This multicentric assessment reveals substantial heterogeneity in Integrated Stewardship implementation across Indian tertiary-care institutions. While diagnostic and infection-control infrastructure is relatively well-established, dedicated antimicrobial stewardship practices—particularly those requiring active prescribing oversight—remain markedly underdeveloped, highlighting a critical gap between structural readiness and functional stewardship.