Faculty helping hospital in India address antibiotic stewardship

A hospital in southern India demonstrated significant reductions in the use of antibiotics since partnering with Michigan Medicine faculty on an antibiotic stewardship program.

UMMS colleagues working on antibiotic stewardship in India: Vineet Chopra, Twisha Patel, Payal Patel, and Keith Kaye.

Early results of the collaboration with Amrita Institute of Medical Sciences, in Kochi, were published in November in Oxford Academic Press’ Open Forum on Infectious Diseases, showing that the effort is saving lives and reducing costs. Leading the Michigan Medicine involvement is study co-author Payal Patel, MD, an Assistant Professor of Infectious Diseases at UMMS and the Medical Director of Antimicrobial Stewardship at the Ann Arbor Veterans Affairs hospital.

“This partnership has been rewarding for me because what they needed in Kochi fits right into what I do at the VA and what I am so passionate about, which is antimicrobial stewardship,” said Patel. “In Kochi, they see diseases that are much more resistant to antibiotics than what we typically see here. It’s a huge challenge. Despite that, they still have been able to make a positive impact.”

Patel’s collaborations in AIMS began in February 2017 when she and other UMMS faculty traveled to India for the first-ever UMMS-Amrita Symposium on Infectious Diseases and Antimicrobial Stewardship. That exploratory conference blossomed into an ongoing collaboration with regular communication and visits to and from the institutions. Amrita had already been working on an antimicrobial resistance program and sought out UMMS to assist in that effort. They were building a program modeled on many successful US programs, including those at Michigan Medicine and the VA, which empower dedicated teams of physicians and pharmacists to tackle antimicrobial resistance through regular inpatient prescription reviews.

“Amrita has a pharmacy school and they are beginning to train pharmacists who go through a dedicated stewardship program, which we think is the right approach,” Patel said. “Our role has primarily been to help them think about how to demonstrate the value of this new model through research.”

She and others, including Professor of Infectious Diseases Keith Kaye, MD, MPH, helped their Amrita colleagues carry out a study to measure the effectiveness the hospital’s new antibiotic stewardship program.

Under the new process, teams evaluate every inpatient prescription for a number of designated restricted drugs, checking for the “5 Rs” (right drug, right indication, right dose, right frequency, and right duration). During the 12-month study period, the team discovered and intervened in more than 2,700 cases of inappropriate therapy. The incorrect duration of the treatment was the most common error, according to the report.

Monthly costs for restricted drugs declined by more than 14% in the post-implementation period. More important, inpatient mortality per 1,000 patients improved from 31.6 to 28.9 in the post-implementation phase, and the average length of stay dropped from 6.6 to 6.4 days. Such improvements, if they could be replicated elsewhere, could be significant for the healthcare system India, which led the world antibiotics consumption from 2000-2010.

“Getting these findings published is significant for our partners because it validates their hard work and shows a way forward,” Patel said. “With these results, it’s possible for the model to get traction elsewhere. It has to be an Indian hospital that leads the way.”

 

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