Exploring the Relationship Between Antimicrobial Stewardship and the Rise of Multi-Drug Resistant Pathogens in Healthcare Settings

Umer Javed; Naveen Taj; Isra Noor; Tehreem Yaseen Shareef; Hafsa Anees; Warisha Khan

doi:10.70749/ijbr.v3i7.1821

Authors

Umer Javed Indus University of Health Sciences, Indus Hospital and Health Care Network, Karachi, Pakistan
Naveen Taj Indus University of Health Sciences, Indus Hospital and Health Care Network, Karachi, Pakistan
Isra Noor Indus University of Health Sciences, Indus Hospital and Health Care Network, Karachi, Pakistan
Tehreem Yaseen Shareef Dow University of Health Sciences, Dow Institute of Medical Technology, Karachi, Pakistan
Hafsa Anees Indus University of Health Sciences, Indus Hospital and Health Care Network, Karachi, Pakistan
Warisha Khan Indus University of Health Sciences, Indus Hospital and Health Care Network, Karachi, Pakistan

DOI:

https://doi.org/10.70749/ijbr.v3i7.1821

Keywords:

Multi-drug resistant pathogens, Antimicrobial stewardship, Antibiotic resistance, Healthcare professionals, Public hospitals, Private hospitals, AMS awareness, MDR occurrence, Infection control, Pakistan

Abstract

The aim of this study was to examine the relationship between the antimicrobial stewardship (AMS) programs and the relationship between these programs and the incidence of multi-drug resistant (MDR) pathogens within a healthcare facility, and how healthcare practitioners are provoked in administering an AMS program. Multi-drug resistance has been a serious health concern of late with the infections more susceptible to healing and patients are at a higher risk. It was a descriptive cross-sectional research performed in a few out of the total number of the governmental and regional hospitals in the province of Punjab in Pakistan during the period between March 1, 2025 and May 15, 2025. A sample of 250 healthcare professionals, was chosen by simple random sampling. A structured questionnaire with self-report was used to carry the observation and measurements. Frequencies and percentages were used to report categorical data whereas the means and standard deviation (SD) were used to report numerical data. Associations and Comparing of Means were performed on chi-square and Independent Samples t-tests. The results showed a high correlation in use of AMS and the incidences of MDR (p = 0.003) with few MDR cases per hospital having AMS implemented to practice. The knowledge of AMS was significantly higher in the case of the public hospitals when compared to those in a private hospital (p = 0.014). There were higher scores of challenges in AMS implementation among nurses and the pharmacists. The results indicate that there is a need to enhance AMS programs.

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References

Darwish, R.M., et al., Impact of antimicrobial stewardship on antibiogram, consumption and incidence of multi drug resistance. BMC Infectious Diseases, 2022. 22(1): p. 916.

https://doi.org/10.1186/s12879-022-07906-1

Pachori, P., R. Gothalwal, and P. Gandhi, Emergence of antibiotic resistance Pseudomonas aeruginosa in intensive care unit; a critical review. Genes & diseases, 2019. 6(2): p. 109-119.

https://doi.org/10.1016/j.gendis.2019.04.001

Serra-Burriel, M., et al., Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis. PloS one, 2020. 15(1): p. e0227139.

https://doi.org/10.1371/journal.pone.0227139

Dalbeni, A., et al., The multi-drug resistant organisms infections decrease during the antimicrobial stewardship era in cirrhotic patients: An Italian cohort study. Plos one, 2023. 18(2): p. e0281813.

https://doi.org/10.1371/journal.pone.0281813

De Waele, J.J., et al., Antimicrobial resistance and antibiotic stewardship programs in the ICU: insistence and persistence in the fight against resistance. A position statement from ESICM/ESCMID/WAAAR round table on multi-drug resistance. Intensive care medicine, 2018. 44(2): p. 189-196.

https://doi.org/10.1007/s00134-017-5036-1

Fernández, J., F. Bert, and M.-H. Nicolas-Chanoine, The challenges of multi-drug-resistance in hepatology. Journal of hepatology, 2016. 65(5): p. 1043-1054.

https://doi.org/10.1016/j.jhep.2016.08.006

Denkinger, C.M., et al., Increased multi-drug resistance among the elderly on admission to the hospital—a 12-year surveillance study. Archives of gerontology and geriatrics, 2013. 56(1): p. 227-230.

https://doi.org/10.1016/j.archger.2012.05.006

Helmi, R.T., Impact of Antimicrobial Stewardship Interventions on Multi-Drug Resistant Organisms at Sultan Qaboos University Hospital. 2023: Sultan Qaboos University (Oman).

Pogue, J., et al., Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens. Clinical Microbiology and Infection, 2015. 21(4): p. 302-312.

https://doi.org/10.1016/j.cmi.2014.12.025

Khadse, S.N., S. Ugemuge, and C. Singh, Impact of antimicrobial stewardship on reducing antimicrobial resistance. Cureus, 2023. 15(12).

https://doi.org/10.7759/cureus.49935

Cantón, R., et al., Inappropriate use of antibiotics in hospitals: the complex relationship between antibiotic use and antimicrobial resistance. Enfermedades infecciosas y microbiologia clinica, 2013. 31: p. 3-11.

https://doi.org/10.1016/s0213-005x(13)70126-5

Morales, E., et al., Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition. BMC health services research, 2012. 12(1): p. 122.

https://doi.org/10.1186/1472-6963-12-122

Cosgrove, S.E., The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clinical Infectious Diseases, 2006. 42(Supplement_2): p. S82-S89.

https://doi.org/10.1086/499406

Idris, F.N. and M.M. Nadzir, Multi-drug resistant ESKAPE pathogens and the uses of plants as their antimicrobial agents. Archives of microbiology, 2023. 205(4): p. 115.

https://doi.org/10.1007/s00203-023-03455-6

Joseph, N.M., et al., Ventilator-associated pneumonia in a tertiary care hospital in India: role of multi-drug resistant pathogens. The Journal of Infection in Developing Countries, 2010. 4(04): p. 218-225.

https://doi.org/10.3855/jidc.634

Balkhair, A., et al., Epidemiology of Multi‐Drug Resistant Organisms in a Teaching Hospital in Oman: A One‐Year Hospital‐Based Study. The Scientific World Journal, 2014. 2014(1): p. 157102.

Al Hamdan, A.S., et al., Evaluating the prevalence and the risk factors of gram-negative multi-drug resistant bacteria in Eastern Saudi Arabia. Infection and Drug Resistance, 2022: p. 475-490.

https://doi.org/10.2147/idr.s350048

Zhang, Y., et al., Wastewater treatment contributes to selective increase of antibiotic resistance among Acinetobacter spp. Science of the Total Environment, 2009. 407(12): p. 3702-3706.

https://doi.org/10.1016/j.scitotenv.2009.02.013

Datta, S., et al., A ten year analysis of multi-drug resistant blood stream infections caused by Escherichia coli & Klebsiella pneumoniae in a tertiary care hospital. Indian Journal of Medical Research, 2012. 135(6): p. 907-912.

Kuo, S.-C., et al., Emergence of extensively drug-resistant Acinetobacter baumannii complex over 10 years: nationwide data from the Taiwan Surveillance of Antimicrobial Resistance (TSAR) program. BMC infectious diseases, 2012. 12(1): p. 200.

https://doi.org/10.1186/1471-2334-12-200

Alghamdi, S., et al., Antimicrobial stewardship programmes in Saudi hospitals: evidence from a national survey. Antibiotics, 2021. 10(2): p. 193.

Finland, M., Emergence of antibiotic resistance in hospitals, 1935–1975. Reviews of infectious diseases, 1979. 1(1): p. 4-21.

https://doi.org/10.1093/clinids/1.1.4

Zahlane, K., A.T. Ouafi, and M. Barakate, The clinical and epidemiological risk factors of infections due to multi-drug resistant bacteria in an adult intensive care unit of University Hospital Center in Marrakesh-Morocco. Journal of infection and public health, 2020. 13(4): p. 637-643.

https://doi.org/10.1016/j.jiph.2019.08.012

Solomon, F.B., et al., Antibiotic resistant airborne bacteria and their multidrug resistance pattern at University teaching referral Hospital in South Ethiopia. Annals of clinical microbiology and antimicrobials, 2017. 16(1): p. 29.

https://doi.org/10.1186/s12941-017-0204-2

Forde, B.M., et al., Clinical implementation of routine whole-genome sequencing for hospital infection control of multi-drug resistant pathogens. Clinical Infectious Diseases, 2023. 76(3): p. e1277-e1284.

https://doi.org/10.1093/cid/ciac726

Abavisani, M., M. Keikha, and M. Karbalaei, First global report about the prevalence of multi-drug resistant Haemophilus influenzae: a systematic review and meta-analysis. BMC Infectious Diseases, 2024. 24(1): p. 90.

https://doi.org/10.1186/s12879-023-08930-5

Iramiot, J.S., et al., Antimicrobial resistance at the human–animal interface in the Pastoralist Communities of Kasese District, South Western Uganda. Scientific Reports, 2020. 10(1): p. 14737.

Varshney, S., S. Sharma, and D. Gupta, Surveillance of bacterial load and multi-drug resistant bacteria on bedsheets in a primary health care unit. International Journal of Environmental Health Research, 2022. 32(9): p. 2040-2051.

https://doi.org/10.1080/09603123.2021.1935780

Byarugaba, D., Antimicrobial resistance in developing countries and responsible risk factors. International journal of antimicrobial agents, 2004. 24(2): p. 105-110.

Shaikh, O.A., et al., Antimicrobial resistant strains of Salmonella typhi: The role of illicit antibiotics sales, misuse, and self-medication practices in Pakistan. Journal of infection and public health, 2023. 16(10): p. 1591-1597.

https://doi.org/10.1016/j.jiph.2023.08.003

Cheng, G., et al., Selection and dissemination of antimicrobial resistance in Agri-food production. Antimicrobial Resistance & Infection Control, 2019. 8(1): p. 158.

https://doi.org/10.1186/s13756-019-0623-2

Phodha, T., et al., Excess annual economic burdens from nosocomial infections caused by multi-drug resistant bacteria in Thailand. Expert Review of Pharmacoeconomics & Outcomes Research, 2019. 19(3): p. 305-312.

https://doi.org/10.1080/14737167.2019.1537123

Gandra, S., et al., The mortality burden of multidrug-resistant pathogens in India: a retrospective, observational study. Clinical infectious diseases, 2019. 69(4): p. 563-570.

https://doi.org/10.1093/cid/ciy955

Nijsingh, N., et al., Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable? Monash Bioethics Review, 2020. 38(Suppl 1): p. 72-90.

https://doi.org/10.1007/s40592-020-00113-1

Church, N.A. and J.L. McKillip, Antibiotic resistance crisis: challenges and imperatives. Biologia, 2021. 76(5): p. 1535-1550.

https://doi.org/10.1007/s11756-021-00697-x

Boyles, T.H., et al., Antibiotic stewardship ward rounds and a dedicated prescription chart reduce antibiotic consumption and pharmacy costs without affecting inpatient mortality or re-admission rates. PloS one, 2013. 8(12): p. e79747.

https://doi.org/10.1371/journal.pone.0079747