A systematic review of the effectiveness and cost-effectiveness of implementing antimicrobial stewardship program at tertiary care facilities in India

Abstract

Objectives: This systematic review was performed to assess the effectiveness and cost-effectiveness of antimicrobial stewardship programs (ASPs) in Indian tertiary care facilities. Methods: Searches were performed in PubMed, Scopus, Cochrane Library, Google Scholar, Epistemonikos, and ScienceDirect up to July 2024. Data on antimicrobial consumption, resistance patterns, patient outcomes, and economic evaluations were extracted using standardized form. This review included 29 studies from various Indian states, and, due to heterogeneity in study type, narrative synthesis was performed. Results: ASP interventions-such as guideline implementation, antibiotic prescription audits with feedback, and clinician education-were associated with significant reductions in overall antibiotic use (up to 32% reduction in neonatal intensive care units) and improvements in resistance patterns (decrease in methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus rates). Patient-related outcomes, including reduced length of hospital stay and lower rates of health care-associated infections, were observed, although changes in mortality were variable. Economic analyses demonstrated substantial cost savings and favorable cost-effectiveness profiles. Conclusions: ASPs in Indian tertiary care settings are clinically effective and economically viable, reducing antimicrobial misuse, curbing resistance, and improving patient outcomes, while lowering health care costs. Further research using standardized metrics and extending to other health care levels is needed to optimize and sustain ASP benefits.