The growing challenge of bacteria developing resistance to antibiotics due to indiscriminate usage is becoming increasingly apparent worldwide. However, there is a conspicuous dearth of antibiotic stewardship programmes in hospitals of Bengaluru aimed at curbing this grave issue.
The alarming revelation is that out of several hundred healthcare institutions present in Bengaluru, merely around 80 possess accreditation from the National Accreditation Board for Hospitals and Healthcare Providers (NABH). Given that NABH mandates institutions to have an antibiotic stewardship programme, it’s concerning to note that the majority of the city’s healthcare facilities are absent in this regard.
Often, these accredited hospitals are larger establishments, part of expansive healthcare chains, leaving smaller hospitals without access to such programs. The NABH is a pivotal constituent of the Quality Council of India, powered by the central government.
One of the primary requirements for hospitals under an antibiotic stewardship programme is the establishment of a comprehensive antibiotic policy. This policy delineates the spectrum of antibiotics that can be routinely used, those that are restricted, and those explicitly earmarked for infection prevention during surgical procedures. Typically, doctors are advised to start with the mildest effective antibiotic and scale up if necessary. Access to restricted antibiotics calls for explicit permission from a monitoring officer. A large number of hospitals derive their antibiotic policies from guidance by distinguished bodies such as the Indian Council of Medical Research (ICMR) and the Centers for Disease Control and Prevention (CDC).
However, the NABH encourages hospitals to tailor their antibiotic policy based on a unique antibiogram, a testament to the level of resistance displayed by various bacterial strains in that particular hospital setting. If there is a marked increase in resistance to a specific antibiotic, it is prudent to desist from its usage temporarily. Since bacterial culture reports can take up to 48 hours, the initial antibiotic provided needs to be effective to prevent deterioration in the patient’s condition, asserts infectious disease specialist Dr. John Paul. Yet, a glaring gap exists in the process – the insufficient monitoring of the implementation of antibiotic policies within hospitals. Hospitals are expected to conduct their documentation and analyses, but aren’t obligated to regularly share the findings with NABH. These reports only come under NABH scrutiny while the institution undergoes an inspection for accreditation renewal every three years.
Many hospitals lack a microbiology lab, preventing them from obtaining sufficient test results to form an antibiogram. On the other hand, some hospitals maintain their antibiograms annually, which means that changes in bacterial behavior manifested in the preceding three months are lost.
Dr. Chintan Kaswala, an infectious disease specialist, stresses the need for data from hospitals to be publicly accessible, which would shed light on prevalent community infections and sensitive drugs, thereby aiding in effective antibiotic prescription. This approach could also enhance transparency within the system.