Integrated Antimicrobial Stewardship in India: Consensus on Best Practices, Current Baseline, and Identified Barriers

Background: India faces unique challenges in tackling antimicrobial resistance (AMR) due to the high prevalence of infections, irrational antibiotic use, and varied healthcare infrastructure. Integrated stewardship practices are key to combating AMR. This study uses a questionnaire to assess the prevalence and barriers to integrated antimicrobial stewardship across tertiary healthcare settings, proposing actionable strategies for improvement. Methods: This cross-sectional Delphi survey under the Society of Antimicrobial Stewardship PractIces (SASPI) Consortium assessed integrated antimicrobial stewardship (IAS) practices across 31 Indian tertiary care institutions. Using a validated 42-item questionnaire, it evaluated stewardship programs, accountability, prescriber education, laboratory protocols, and infection control. Data were analysed using SPSS. Practices were analysed as subcategories- administrative, antimicrobial, diagnostic, and infection prevention stewardships. Results: 44 responses from 31 tertiary care institutions in India, including 67.7% of institutes of national importance (INI), were analysed. 61.4% of the respondents were members of their hospital’s infection control committee (HICC) or antimicrobial stewardship program (AMSP). The validation of 42 practice statements showed that 41 received over 75% agreement, with adjustments to Practice Statement 6 (72.4%). Key findings revealed poor compliance in a few areas: 29% for assigning pharmacists the antimicrobial utilisation responsibility, 13% for OPAT policies, and 29% for having policies dealing with local infectious diseases. INIs reported lower compliance with integrated stewardship practices than non-INIs, possibly due to the involvement of experts who were not HICC/AMSP members in non-INIs. Key barriers were limited resources, inadequate diagnostic facilities, and a workforce in 42% of the institutes. Conclusion: The study highlights the need for awareness and implementation of IAS practices in tertiary healthcare institutes in India. Addressing this requires the implementation of these practice statements, regular monitoring, resource allocation, training, and collaboration. SASPI can lead to collaboration. Policymakers and institutions must work together to integrate IAS fully, reducing AMR and improving patient outcomes across India.