Impact of De-escalation Review Form as a Part of Antimicrobial Stewardship Program – A Prospective Observational Study

Abstract Context: Antimicrobial resistance (AMR) poses a severe global health threat, with projections indicating potential deaths of up to 10 million annually by 2050. Antimicrobial stewardship programs (AMSPs) are essential in combating AMR by ensuring judicious use of antimicrobials. This study assesses the effectiveness of a de-escalation review form implemented within an AMSP to optimize the use of restricted antimicrobials (RAMs). Aims: The aim of this study was to evaluate the impact of implementing a de-escalation review form within an AMSP on the de-escalation of RAMs. Specifically, we sought to assess whether the introduction of this form would increase the rate of appropriate de-escalations, improve documentation and justification for continued use of RAMs, and ultimately enhance the overall effectiveness of antimicrobial stewardship in reducing AMR. Settings and Design: An observational, prospective study was conducted at a tertiary care multicentered hospital, India. Inclusion Criteria: All the inpatients on RAMs in wards and intensive care units (ICUs) are included in the study. Exclusion Criteria: All outpatients, patients on lower antimicrobials, and patients for whom STAT doses of RAMs are advised are excluded from the study. Subjects and Methods: We conducted a prospective observational study including inpatients on RAMs across wards and ICUs. The AMSP involved collecting a de-escalation review form of RAMs within 24 h of initiating RAMs. The form captured clinical parameters and guided infectious disease (ID) specialists in recommending de-escalation. Data from before and after the introduction of the RAM form were analyzed for de-escalation rates and associated outcomes. Statistical Analysis Used: SPSS software was used for statistical analysis. Results: The implementation of the RAM form led to a 44% increase in de-escalations for culture-negative cases and an 11% increase for culture-positive cases compared to preintervention rates. The form facilitated improved documentation and justification for nonde-escalation cases. Notable reductions in antimicrobial use and associated costs were observed, alongside improved adherence to AMSP guidelines. Conclusions: The introduction of the de-escalation review form significantly enhanced the de-escalation process within the AMSP, leading to better antimicrobial use and reduced resistance risks. This tool proved effective in promoting more judicious antimicrobial prescribing practices and can serve as a model for other institutions aiming to optimize antimicrobial stewardship efforts.