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Objective To establish a framework for implementing antimicrobial stewardship in Indian tertiary care hospitals, and identify challenges and enablers for implementation. Methods Over 2018-2021 the Indian Council of Medical Research followed a systematic approach to establish a framework for implementation of antimicrobial stewardship in Indian hospitals. We selected 20 Indian tertiary care hospitals to study the feasibility of implementing a stewardship programme. Based on a questionnaire to lead physicians before and after the intervention, we assessed progress using a set of process and outcome indicators. In a qualitative survey we identified enablers and barriers to implementation of antimicrobial stewardship. Findings We found an improvement in various antimicrobial stewardship implementation indicators in the hospitals after the intervention. All 20 hospitals conducted monthly point prevalence analysis of cultures compared with three hospitals before the intervention. The number of hospitals that initiated formulary restrictions increased from two to 12 hospitals and the number of hospitals that started practising prescription audit and feedback increased from six to 16 hospitals. Respondents in 15 hospitals expressed their willingness to expand the coverage of antimicrobial stewardship implementation to other wards and intensive care units. Six hospitals were willing to recruit the permanent staff needed for antimicrobial stewardship activities. Conclusion Antimicrobial stewardship can be implemented in Indian tertiary hospitals with reasonable success, subject to institutional support, availability of trained manpower and willingness of hospitals to support antimicrobial stewardship-related educational and training activities. Objectif Etablir un cadre pour la mise en ceuvre d'une gestion des antimicrobiens dans les hopitaux de soins tertiaires en Inde, et identifier les defis et les moteurs de cette mise en oeuvre. Methodes Durant la periode comprise entre 2018 et 2021, le Conseil indien de la recherche medicale a adopte une approche systematique visant a instaurer un cadre pour assurer la gestion des antimicrobiens dans les hopitaux indiens. Nous avons selectionne 20 hopitaux de soins tertiaires en Inde afin d'etudier la faisabilite du deploiement d'un tel programme. En nous fondant sur un questionnaire soumis aux medecins-chefs avant et apres l'intervention, nous avons evalue les progresau moyen d'une seried'indicateurs relatifsaux processus et aux resultats. Par le biais d'une enquete qualitative, nous avons determine quels etaient les obstacles et facteurs favorables a la mise en ceuvre d'une gestion des antimicrobiens. Resultats Nous avons constate une ameliorationau niveau de plusieurs indicateurs de mise en ceuvre dans les hopitauxa Tissue de l'intervention. Les 20 etablissements ont tous mene chaque mois une analyse de prevalence ponctuelle des cultures, alors qu'ils n'etaient que trois a le faire avant l'intervention. Le nombre d'hopitaux ayant introduit une dispensation controlee est passe de deux a 12, et ils sont desormais 16 a verifier et reguler les prescriptions, contre six auparavant. Dans 15 etablissements, les participants ont exprime leur volonte d'etendre ces pratiques a d'autres services et unites de soins intensifs. Enfin, six hopitaux etaient prets a recruter le personnel requis pour accomplir des taches liees a la gestion des antimicrobiens. Conclusion La mise en ceuvre de ce type de gestion peut rencontrer un certain succes dans les hopitaux tertiaires en Inde. Ce succes depend notamment de l'aide qu'apportent les institutions, de l'acces a une main-d'ceuvre qualifiee et de la volonte des hopitaux a soutenir les activites de formation et d'education a la gestion des antimicrobiens. Objetivo Establecer un marco para la aplicacion del programa de optimizacion del uso de antimicrobianos en los hospitales de atencion especializada de la India, e identificar los desafios y los factores que facilitan la aplicacion. Metodos Entre 2018 y 2021, el Consejo Indio de Investigacion Medica siguio un enfoque sistematico para establecer un marco que permitiera la aplicacion de la optimizacion del uso de antimicrobianos en los hospitales de la India. Se seleccionaron 20 hospitales de atencion especializada de la India para estudiar la viabilidad de implementar un programa de optimizacion de uso. A partir de un cuestionario dirigido a los medicos principales antes y despues de la intervencion, se evaluaron los avances mediante un conjunto de indicadores de procesos y desenlaces. En una encuesta cualitativa, se identificaron los factores que facilitan la optimizacion del uso de antimicrobianos y los obstaculos que la dificultan. Resultados Se encontro una mejora en varios indicadores de optimizacion del uso de antimicrobianos en los hospitales despues de la intervencion. Los 20 hospitales realizaron analisis mensuales de prevalencia puntual de cultivos, en comparacion con tres hospitales antes de la intervencion. La cantidad de hospitales que iniciaron restricciones en el formulario aumento de dos a 12 hospitales y la cantidad de hospitales que comenzaron a practicar la auditoria de prescripcion y la retroalimentacion aumento de seis a 16 hospitales. Los encuestados de 15 hospitales expresaron su voluntad de ampliar la cobertura del programa de optimizacion del uso de antimicrobianos a otras salas y unidades de cuidados intensivos. Seis hospitales estaban dispuestos a contratar el personal permanente necesario para las actividades de optimizacion del uso de antimicrobianos. Conclusion La optimizacion del uso de antimicrobianos se puede aplicar en los hospitales de atencion especializada de la India sin problemas, siempre que se cuente con el apoyo de las instituciones, la disponibilidad de personal capacitado y la voluntad de los hospitales de apoyar las actividades educativas y de formacion relacionadas con la optimizacion del uso de antimicrobianos., Introduction In recent years, several low- and middle-income countries, including India, have reported alarming rates of antimicrobial resistance. The Global action plan on antimicrobial resistance released by the World Health [...]

Objective To assess the preparedness of veterinary laboratories in India to participate in an integrated antimicrobial resistance surveillance network and to address gaps in provision identified. Methods The Indian Council of Medical Research and the Indian Council of Agricultural Research collaborated: (i) to select eight nationally representative veterinary microbiology laboratories whose capacity for participating in an integrated antimicrobial resistance surveillance network would be assessed using a standardized tool; (ii) to identify gaps in provision from the assessment findings; and (iii) to develop a plan, and take the necessary steps to address these gaps in consultation with participating organizations. Findings The main gaps in provision identified were: (i) a lack of dedicated funding for antimicrobial resistance surveillance; (ii) the absence of standard guidelines for antimicrobial susceptibility testing; (iii) a shortage of reference strains for testing and quality assurance; and (iv) the absence of mechanisms for sharing data. We addressed these gaps by creating a veterinary standard operating procedure for antimicrobial susceptibility testing, by carrying out a validation exercise to identify problems with implementing the procedure and by conducting capacity-building workshops for veterinary laboratories. Conclusion Antimicrobial resistance surveillance networks depend on the availability of accurate, quality-controlled testing. The challenges identified in creating an integrated surveillance network for India can be overcome by developing a comprehensive plan for improving laboratory capacity in human, veterinary and environmental sectors that is supported by the necessary funds. The study's findings may provide guidance for other low- and middle-income countries planning to develop a similar network. Un reseau de surveillance integre pour la resistance aux antimicrobiens en Inde Objectif Evaluer le degre de preparation des laboratoires veterinaires en Inde dans l'optique d'une participation a un reseau de surveillance integre pour la resistance aux antimicrobiens, et combler les lacunes identifiees dans le systeme. Methodes Le Conseil indien de la recherche medicale et le Conseil indien de la recherche agronomique ont travaille ensemble afin de: (i) selectionner huit laboratoires de microbiologie veterinaire representatifs a l'echelle nationale, dont la capacite de participation a un tel reseau serait evaluee grace a un outil standardise; (ii) determiner quelles sont les faiblesses du systeme a partir des resultats de l'evaluation; et, enfin, (iii) developper un plan et prendre les mesures necessaires pour remedier a ces faiblesses, en concertation avec les organismes participants. Resultats Les principales lacunes observees dans le systeme etaient: (i) l'absence de fonds dedies a la surveillance de la resistance aux antimicrobiens; (ii) l'absence de directives types pour le test de sensibilite aux antimicrobiens; (iii) le manque de souches de reference pour les tests et l'assurance qualite; et, enfin, (iv) l'absence de mecanismes de partage de donnees. Nous avons comble ces lacunes en creant une procedure operationnelle standardisee a usage veterinaire pour le test de sensibilite aux antimicrobiens, en menant un exercice de validation afin d'identifier les problemes rencontres lors de la mise en oeuvre de la procedure, et en organisant des ateliers de renforcement des capacites pour les laboratoires veterinaires. Conclusion Les reseaux de surveillance pour la resistance aux antimicrobiens dependent de l'existence ou non de tests precis faisant l'objet de controles de qualite. Les defis que pose la creation d'un reseau de surveillance integre en Inde peuvent etre releves grace a l'elaboration d'un plan global d'amelioration des capacites humaines, veterinaires et environnementales des laboratoires en y injectant les fonds requis. Les resultats de cette etude peuvent servir d'orientation pour d'autres pays a faibles et moyens revenus qui prevoient d'instaurer un reseau similaire. Una red de vigilancia integrada para la resistencia antimicrobiana resistencia a los antimicrobianos, India Objetivo Evaluar la preparacion de los laboratorios veterinarios de la India para participar en una red integrada de vigilancia de la resistencia a los antimicrobianos y subsanar las deficiencias detectadas en la prestacion. Metodos El Consejo Indio de Investigacion Medica y el Consejo Indio de Investigacion Agricola colaboraron: (i) para seleccionar ocho laboratorios de microbiologia veterinaria representativos a nivel nacional cuya capacidad para participar en una red integrada de vigilancia de la resistencia a los antimicrobianos seria evaluada mediante una herramienta estandarizada; (ii) para identificar las lagunas en la prestacion a partir de los resultados de la evaluacion; y (iii) para desarrollar un plan, y tomar las medidas necesarias para abordar estas lagunas en consulta con las organizaciones participantes. Resultados Las principales lagunas identificadas son las siguientes (i) la falta de financiacion dedicada a la vigilancia de la resistencia a los antimicrobianos; (ii) la ausencia de directrices estandar para las pruebas de susceptibilidad a los antimicrobianos; (iii) la escasez de cepas de referencia para las pruebas y la garantia de calidad; asi como (iv) la ausencia de mecanismos para compartir datos. Para subsanar estas deficiencias, creamos un procedimiento operativo estandar veterinario para las pruebas de susceptibilidad a los antimicrobianos, llevamos a cabo un ejercicio de validacion para identificar los problemas de aplicacion del procedimiento y realizamos talleres de capacitacion para los laboratorios veterinarios.Conclusion Las redes de vigilancia de la resistencia a los antimicrobianos dependen de la disponibilidad de pruebas precisas y de calidad controlada. Los retos identificados en la creacion de una red de vigilancia integrada para la India pueden superarse mediante el desarrollo de un plan integral para mejorar la capacidad de los laboratorios en los sectores humano, veterinario y medioambiental que cuente con los fondos necesarios. Las conclusiones del estudio pueden servir de orientacion a otros paises de ingresos bajos y medios que se propongan crear una red similar., Introduction The misuse and overuse of antimicrobials in both humans and animals are major drivers of antimicrobial resistance. (1-3) Several clinically important antibiotics are used extensively in food-producing animals, either [...]

Background: Over the past decades, the increasing incidence of recurrent dermatophytosis associated with terbinafine‐resistant Trichophyton has posed a serious challenge in management of dermatophytosis. Independent reports of failure of treatment and high minimum inhibitory concentrations (MIC) of antifungals are available, but data correlating MIC and clinical outcomes is still sparse. Therefore, the present study was conducted to evaluate the outcomes of systemic treatment of dermatophytosis and its correlation with MIC of the etiological agents isolated from such patients. Methods: Retrospective analysis of 587 consecutive patients with dermatophytosis was done from March 2017 to March 2019. Demographic and clinical details of the patients were noted, along with the results of direct microscopy and fungal culture. The isolates were identified by sequencing the internal transcribed spacer region of rDNA. Antifungal susceptibility testing was performed following the CLSI M38 protocol. Mutation in the squalene epoxidase (SE) gene was detected by DNA sequencing and ARMS‐PCR. Based on the culture‐positivity and prescribed systemic antifungal, patients were categorised into Group I culture‐positive cases treated with systemic terbinafine and Group II culture‐positive cases treated with systemic itraconazole, each for a total period of 12 weeks. Results: In the present study, 477 (81.39%) were culture‐positive; however, 12 weeks follow‐up was available for 294 patients (Group I‐157 and Group II‐137) who were included for statistical analysis. In both groups [Group I‐37/63 (51.4%) and Group II‐14/54 (58.3%)], a better cure rate was observed if the initiation of therapy was performed within <6 months of illness. Treatment outcome revealed that if therapy was extended for 8–12 weeks, the odds of cure rate are significantly better (p <.001) with either itraconazole (Odd Ratio‐15.5) or terbinafine (Odd Ratio‐4.34). Higher MICs for terbinafine were noted in 41 cases (cured‐18 and uncured‐23) in Group I and 39 cases (cured‐16 and uncured‐23) in Group II. From cured (Group I‐17/18; 94.4% and Group II‐14/16; 87.5%) and uncured (Group I‐20/23; 86.9% and Group II‐21/23; 91.3%) cases had F397L mutation in the SE gene. No significant difference in cure rate was observed in patients with Trichophyton spp. having terbinafine MIC ≥ 1or <1 μg/mL (Group I‐p =.712 and Group II‐p =.69). Conclusion: This study revealed that prolonging terbinafine or itraconazole therapy for beyond 8 weeks rather than the standard 4 weeks significantly increases the cure rate. Moreover, no correlation has been observed between antifungal susceptibility and clinical outcomes. The MIC remains the primary parameter for defining antifungal activity and predicting the potency of antifungal agents against specific fungi. However, predicting therapeutic success based solely on the MIC of a fungal strain is not always reliable, as studies have shown a poor correlation between in vitro data and in vivo outcomes. To address this issue, further correlation of antifungal susceptibility testing (AFST) data with clinical outcomes and therapeutic drug monitoring is needed. It also highlights that initiation of the treatment within <6 months of illness increases cure rates and reduces recurrence. Extensive research is warranted to establish a better treatment regime for dermatophytosis. [ABSTRACT FROM AUTHOR]

Accurate and affordable diagnostics are central to effective health care. Quality diagnostics, when made available as part of health-care services, influence disease diagnosis and treatment outcomes in patients and improve [...]