Journal of Antimicrobial Stewardship Practices and Infectious diseases (JASPI)
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Item Scrub Typhus During Pregnancy: A Study from Northeast India(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-03) Jamil, Md; Bhattacharya, PK; Lynrah, KG; Sharma, NIntroduction: Scrub typhus is a crucial underrecognized cause of undifferentiated febrile illness in Northeastern India. Scrub typhus in pregnancy is an uncommon entity. In such cases, not initiating effective and safe antibiotics leads to maternal and fetal complications. To reduce complications, it is a must to keep a high index of clinical suspicion. Methodology: The present study was conducted to find the various disease manifestations of scrub typhus during pregnancy from January 2014 to December 2018. It was a retrospective study that included hospitalized patients with a diagnosis of scrub typhus during pregnancy. The scrub typhus was diagnosed based on the clinical presentation and serological test with Weil-Felix test titer for OXK more or equal to 1:160 or immunochromatographic test positive for scrub typhus IgM antibody. Result: During the study period, complete data were obtained from nine patients. The mean age of the patient was 26.5 years. A maximum of five patients presented in the third trimester, and two presented each in the first and second trimesters. Adverse fetal outcome was found in 33.3% of cases. Two patients had multiorgan dysfunction syndrome, and hepatitis was found to be a common occurrence. Conclusion: Scrub typhus during pregnancy presents a unique problem that is associated with high fetal loss and maternal complications. Keeping a high index of suspicion for diagnosis in endemic regions is essential, as prompt initiation of safe and effective antibiotics can prevent complications.Item Cefoperazone-Sulbactam Induced Coagulopathy: A Lesson In Pharmacokinetics(Society for Antimicrobial Stewardship PractIces (SASPI), 2023-12) S, S; M, V; Mallesh, D; Selvaraj, JCefoperazone-sulbactam is a widely used antibiotic, but clinicians must remain vigilant about potential side effects. We describe an elderly lady on immunosuppressive therapy admitted with suspected sepsis. She was empirically started on cefoperazone-sulbactam. The International normalized ratio (INR) progressively increased over the next few days. Cefoperazone-sulbactam-induced coagulopathy was suspected. INR normalized after antibiotic discontinuation and vitamin K supplementation. Several factors predispose to cefoperazone sulbactam-induced coagulopathy. Some factors include poor dietary vitamin K intake and intestinal bacterial interference with vitamin K synthesis in broad-spectrum antibiotic therapy. The serum half-life of cefoperazone is increased 2�4 fold in patients with hepatic disease and biliary obstruction. A total daily dosage above 4 g should not be necessary in such patients. Higher dosages in such situations increase the risk of toxicity. Cefoperazone therapy may prolong INR. Monitoring INR is indicated when high doses are used or when there is liver disease/biliary obstruction, renal impairment, or both.Item Extensive Deep Vein Thrombosis: A Rare Manifestation Of Disseminated Tuberculosis(Society for Antimicrobial Stewardship PractIces (SASPI), 2023-12) Swaroop, S; Singla, P; Baitha, U; Gupta, G; Singh, AA 20-year-old male with disseminated tuberculosis (pulmonary, pleural, and lymph node TB) presented with unusual manifestation in the form of extensive deep vein thrombosis (DVT) involving bilateral popliteal veins, femoral veins, iliac veins, and infra-hepatic inferior vena cava (IVC). Upon follow-up with the patient after two months of therapy, there was a significant clinical improvement, and edema and tenderness of the lower limb had decreased.Item Bacterial Peritonitis among Chronic Liver Disease Patients - A Cross-sectional Study from Northeast India(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-03) Tiewsoh, I; Mitra, A; Lynrah, KG; Bhattacharya, PK; Lyngdoh, CJ; Tariang, GRB; Lyngdoh, M; War, GBackground: In the present era of increasing antimicrobial resistance in multiple infections, many studies have shown that even with spontaneous bacterial peritonitis (SBP), the bacteriological and resistance patterns have changed over the years with regional variations. This study was conducted to determine the bacteriological profile of peritonitis patients among the group of cirrhotic patients and their outcomes. Methodology: This was a one-year cross-sectional observational study in which cirrhotic patients with ascites were evaluated for SBP. Cytological analysis, biochemical tests (albumin, protein, glucose, lactate dehydrogenase), and culture and sensitivity on the ascitic fluid were carried out. Results: 120 cirrhotic patients with ascites were included in the study. Thirty-eight (31.99%) patients had SBP. Classical SBP was present in 13 patients (34.21%), bacterascites in 7 patients (18.42%) and culture-negative neutrocytic ascites (CNNA) in 18 patients (47.36%). Escherichia coli was the most common organism (50%, n=10), followed by Acinetobacter spp. (15%, n=3), Klebsiella pneumoniae, Enterobacter spp. and Enterococcus spp. (10%, n=2 each), and methicillin-sensitive Staphylococcus aureus (MSSA) (5%, n=1). The mortality among the SBP patients was higher than that among the non-SBP patients (42.10% vs. 15.85%, p=0.0013). Sepsis (with or without septic shock) and renal failure were the most common causes of mortality in these SBP patients. Conclusion: The present study showed that culture-positive SBP in cirrhotic patients was mainly attributed to gram-negative bacterial infections. The resistance among common bacterial isolates was high against third-generation cephalosporins and fluoroquinolones. Patients with multidrug-resistant infections had poor outcomes.Item Cerebral Mucormycosis Without Rhino-Orbital Involvement In A Patient With Chronic Kidney Disease(Society for Antimicrobial Stewardship PractIces (SASPI), 2023-12) Das, A; P, AK; Panda, PK; Gupta, AKIsolated cases of cerebral mucormycosis demand high clinical suspicion and prompt diagnosis and treatment. In the present case, the patient was a young diagnosed case of chronic kidney disease (CKD) for two years on maintenance hemodialysis, presented with symptoms of headache and increased intracranial pressure, which necessitated both emergency surgical and medical management and was both diagnosed and managed efficiently. Early recognition of clinical and radiological cues with early institution of a medico-surgical approach, with proper containment of underlying predisposing conditions, is vital for managing mucormycosis. The case elucidates that mucormycosis can present as an isolated cerebral abscess without rhino-orbital involvement. CKD should be considered as a possible immunocompromised state predisposing to mucormycosis.Item Integrated Antimicrobial Stewardship in India: Consensus on Best Practices, Current Baseline, and Identified Barriers(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-12) Singh, H; Panda, PK; Patro, S; Rai, S; S, AS; S, B; B, A; T, V; T, I; SASPI ConsortiumBackground: India faces unique challenges in tackling antimicrobial resistance (AMR) due to the high prevalence of infections, irrational antibiotic use, and varied healthcare infrastructure. Integrated stewardship practices are key to combating AMR. This study uses a questionnaire to assess the prevalence and barriers to integrated antimicrobial stewardship across tertiary healthcare settings, proposing actionable strategies for improvement. Methods: This cross-sectional Delphi survey under the Society of Antimicrobial Stewardship PractIces (SASPI) Consortium assessed integrated antimicrobial stewardship (IAS) practices across 31 Indian tertiary care institutions. Using a validated 42-item questionnaire, it evaluated stewardship programs, accountability, prescriber education, laboratory protocols, and infection control. Data were analysed using SPSS. Practices were analysed as subcategoriesadministrative, antimicrobial, diagnostic, and infection prevention stewardships. Results: 44 responses from 31 tertiary care institutions in India, including 67.7% of institutes of national importance (INI), were analysed. 61.4% of the respondents were members of their hospital�s infection control committee (HICC) or antimicrobial stewardship program (AMSP). The validation of 42 practice statements showed that 41 received over 75% agreement, with adjustments to Practice Statement 6 (72.4%). Key findings revealed poor compliance in a few areas: 29% for assigning pharmacists the antimicrobial utilisation responsibility, 13% for OPAT policies, and 29% for having policies dealing with local infectious diseases. INIs reported lower compliance with integrated stewardship practices than non-INIs, possibly due to the involvement of experts who were not HICC/AMSP members in non-INIs. Key barriers were limited resources, inadequate diagnostic facilities, and a workforce in 42% of the institutes. Conclusion: The study highlights the need for awareness and implementation of IAS practices in tertiary healthcare institutes in India. Addressing this requires the implementation of these practice statements, regular monitoring, resource allocation, training, and collaboration. SASPI can lead to collaboration. Policymakers and institutions must work together to integrate IAS fully, reducing AMR and improving patient outcomes across India.Item Prevalence of Device Associated Hospital acquired infection in a Medical Intensive Care Unit of a Tertiary Care Centre(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-12) Bhushan, D; Hegde, AV; Kumar, V; Kumar, V; T, B; Kumar, P; Varma, S; A, JBackground: Infections acquired within a hospital setting, commonly called healthcare-associated infections (HAIs), are nosocomial infections that are typically absent or in an incubation phase upon admission. The study aimed to determine the prevalence of device-associated HAI and the factors affecting HAI in the Medical Intensive Care Unit (MICU). Methods: A prospective observational study was conducted, including patients admitted to the MICU of a tertiary care medical centre from March 2020 to March 2023. The patient�s total ventilator days, catheter days, central line days, and development of HAI, according to the definition of surveillance, were recorded for each patient. Rates for device-associated infections and device utilisation ratios (DURs) were calculated. Statistical analysis involved descriptive statistics, Kaplan-Meier curve analysis with the Log Rank test, and logistic regression analysis to identify factors associated with HAI. Results: 386 patients were included in the study, of which 52 (13.47%) developed HAI. The DUR for ventilators, catheters, and central lines were found to be 0.502, 0.949, and 0.545, respectively. Ventilator-associated pneumonia (VAP) rate was 16.07 per 1000 ventilator days, the catheter-associated urinary tract infection (CAUTI) rate was calculated to be 1.64 per 1000 catheter days, and the central line-associated bloodstream infection (CLABSI) rate was 1.91 per 1000 central line days. On multivariate analysis, the length of stay [adjusted odds ratio (AOR), 1.292; 95% CI: 1.200-1.391], and history of hospitalisation in the past 90 days (AOR, 6.556; 95% CI: 2.619-16.411) were also found to be independent predictors for HAI. Conclusion: Our institution has lower rates of CAUTI and CLABSI. However, the VAP rate is higher than in studies conducted in an Indian setting. Hence, adopting the INICC multidimensional approach can address and reduce our VAP rateItem Anti-fungal Consumption by Days of Therapy (DOT) Metric in a Teaching Hospital: A Step Towards Anti-fungal Stewardship(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-12) Patel, R; Chauhan, B; Modi, C; Patel, NBackground: Anti-fungal stewardship (AFS) remains an under-explored aspect within antimicrobial stewardship programs, particularly in developing nations. Understanding the trend of anti-fungal agent consumption at our institute will assist with implementing an anti-fungal stewardship program (AFSP) soon. This study was carried out to provide benchmarking data on anti-fungal consumption, compare the consumption of anti-fungal agents among various hospital locations, and identify target locations for AFS. Methods: After the approval of the Institutional Ethics Committee (IEC), a retrospective observational study was conducted at Shree Krishna Hospital, Karamsad. Antifungal consumption was calculated using the Days of Therapy (DOT) metric in adult inpatients in whom systemic antifungal agents (amphotericin B, anidulafungin, caspofungin, fluconazole, flucytosine, and voriconazole) were administered from 2020 to 2022. Data of DOT were captured through the Hospital Information System (HIS) and analysed using Microsoft Excel for Mac version 16.75 (23070901). Results: Over three years, one patient was prescribed anti-fungal agents per 1000 admissions. Overall anti-fungal consumption in the last three years was 2.96 DOT/1000 Patient Days (PD). The consumption has increased over three years from 2.63 DOT/1000 PD in 2020 to 3.81 DOT/1000 PD in 2022. Fluconazole (2.48 DOT/1000 PD) was the most common anti-fungal agent consumed. The highest anti-fungal use was observed in critical care units (7.48 DOT/1000 PD). Conclusion: Our study showed increased consumption of antifungal agents over three years. A prospective study is recommended to assess the rationality of antifungal agent prescriptions in locations with high consumption.Item Defined Daily Dose (DDD): An Essential Metric in the Antimicrobial Stewardship Programmes (AMSPs) in the Healthcare Sector(Society for Antimicrobial Stewardship PractIces (SASPI), 2023-12) Misra, AK; Sharma, S; Rai, S; C, M; Rangari, G; Katiboina, SR; Kutikuppala, LV S; V, T; R, SAntimicrobial stewardship programmes (AMSPs) decrease antimicrobial resistance, optimize usage of antimicrobials, and enhance patient outcomes. The Anatomical Therapeutic Chemical (ATC) is the foundation of the World Health Organization (WHO) global methodology, which groups the pharmacologically active substances of antimicrobials according to their therapeutic, pharmacological, and chemical characteristics and the organ or system on which they work. Since varied unit doses of daily administration of antimicrobials are prescribed, it is best to utilize a standard approach to measure antimicrobial intake. The Defined Daily Dose (DDD) is awarded to active ingredients with an active ingredient code currently in effect. It is the anticipated average daily maintenance dose of an antimicrobial drug or substances used for their primary indication in adults. The ATC/DDD approach was created to enhance patient care by tracking antimicrobial usage and conducting research. Healthcare facilities would benefit immensely from establishing an antimicrobial stewardship programme, and more research is required to determine the baseline of antimicrobial consumption in the country.Item Efficacy of a Customized Holistic Traditional Complementary Alternative Medicine Protocol for Improving Immunological, Metabolic, and Clinical Parameters in Mild to Moderate COVID-19 Patients: A Pilot Randomized Controlled Trial(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-12) Mirza, AA; Gaur, A; Kalyani, CV; Rohilla, KK; Goyal, B; J, M; B, AS; Panda, PK; Yadav, SR; Gupta, R; Malik, SBackground: The COVID-19 pandemic has necessitated exploring various treatment options, including Traditional Complementary and Alternative Medicine. This study aims to evaluate the efficacy of a customised Holistic Traditional Complementary Alternative Medicine (HTCAM) protocol in improving immunological, metabolic, and inflammatory outcomes in patients with mild to moderate COVID-19. Methods: This pilot randomised controlled trial involved 100 patients, 50 in the HTCAM intervention group and 50 in the control group. Participants were adults diagnosed with mild to moderate COVID-19. Following 1:1 randomisation, baseline data were collected, including blood samples for interleukins, oxidative stress, and metabolic parameters. The HTCAM group received a detailed, customised protocol with daily supervision and clinical monitoring. Blood samples were collected at discharge or on the 7th day post-enrollment. Statistical analysis was performed using SPSS version 25.0, employing mean, standard deviation, chi-square tests, and independent t-tests, with significance set at p < 0.05. Results: Sociodemographic and clinical variables showed no significant differences between groups. Significant improvements in the HTCAM group were observed in creatinine and triglyceride levels compared to the control group. Significant differences were also noted in serum albumin and TNF-alpha levels, enhancing inflammation management and overall health. Conclusion: This pilot trial suggests combining the Holistic Traditional Complementary Alternative Medicine (HTCAM) protocol with conventional COVID-19 treatment may improve clinical and metabolic parameters. Significant benefits were observed in serum albumin levels and reductions in TNF-alpha, with HTCAM also maintaining stable ferritin levels and positively influencing triglycerides and creatinine. Further research must confirm these findings and clarify HTCAM's role in COVID-19 management.Item Antimicrobial Stewardship Program at a Tertiary Care Hospital: A Road Less Travelled(Society for Antimicrobial Stewardship PractIces (SASPI), 2023-12) Varma, SC; Mandal, AK; Sharma, A; Chawla, PK; Juneja, S; Singh, P; Kumar, AThe manuscript provides a practical overview of implementing an antimicrobial stewardship program from a very nascent stage to a well-established program in the complex setting of a tertiary care hospital. It gives the readers a road map to initiate or refine their journey utilizing many principles of quality improvement, common sense, and negotiating complex human behavior. It also showcases a good use of the scientific principles of quality improvement and change management. Starting small with well-defined surgical prophylaxis paved the way for the complex world of empirical prescription of antimicrobials later in this journey. Various strategies like prescription audit and feedback, handshake stewardship, antimicrobial time-out, and greater mindfulness towards antimicrobial prescription have been well highlighted. Regular point prevalence surveys provided us with actionable data for multiple interventions. Moreover, it highlights the well-defined process and outcome metrics that measured the various aspects of antimicrobial prescription and were instrumental in assessing the success or challenges in implementing the program. Compliance with surgical prophylaxis improved from 34 % to 71%, while compliance with de-escalation increased from 38% to 57%.Item Carbapenem-resistant Bacteremia and Metastatic Abscesses - A Community-acquired Infection of Concern(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-12) Kumar, A; Akhtar, M; Panda, PKSystemic dissemination of uropathogens from the genitourinary tract resulting in the formation of psoas and chest wall abscesses represents a rare yet significant complication of urinary tract infections (UTIs). This phenomenon is widespread in high-risk individuals like those with poorly controlled diabetes mellitus, and if left untreated, can lead to severe, potentially fatal outcomes. The community is increasingly concerned about the infections caused by multidrug-resistant pathogens. Here, a man in his 50s with uncontrolled type 2 diabetes (HbA1c = 16.6%) presented with fever, chills, rigours, and right flank pain worsening with hip extension, occasionally radiating to the groin. He developed a painful swelling on the right upper chest with erythema. Diagnostic workup revealed metastatic infection by a carbapenem-resistant Escherichia coli, which began as bilateral pyelonephritis and progressed to bacteremia, psoas abscess, and thoracic wall abscess. All abscesses were resolved with amikacin treatment, which led to a favourable outcome. This case highlights the atypical presentations of carbapenem-resistant Escherichia coli pyelonephritis as well as the diagnostic challenge of atypical Carbapenem-resistant Enterobacterales [CRE] infections in high-risk diabetic patients, emphasising the need for blood and pus cultures to identify multi-drug resistant (MDR) pathogens and guide effective treatment, and prevent antimicrobial resistance (AMR), alongside community education and individualised care for prevention and early intervention.Item Navigating the Dual Threat: Cryptococcal and Tubercular Co-infections in PLHIV(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-09) Kumar, B; Kumar, D; Meena, DS; Kanagiri, T; Bohra, GK; Midha, NKCo-infections of cryptococcosis and tuberculosis (TB) represent a significant clinical challenge, particularly in people living with HIV, due to their compounded impact on an already compromised immune system. Cryptococcus neoformans and Mycobacterium tuberculosis exploit immune dysfunction, often resulting in severe, disseminated infections with overlapping clinical symptoms, which complicates diagnosis and delays appropriate treatment. A 55-year-old HIV-positive male, recently initiated on ART (TLD regimen) was admitted with fever, headache, vomiting, irritability, and altered behavior. Poor adherence to ART and a CD4 count of 210 cells/cumm raised concerns about a CNS opportunistic infection, possibly cryptococcal meningitis, and immune reconstitution inflammatory syndrome (IRIS). Examination revealed fever, irritability, neck stiffness, and positive Kernig's signs. Cryptococcal antigen was positive, and imaging suggested both cryptococcal and tubercular meningitis. Bronchoalveolar lavage confirmed tuberculosis. The patient was treated with liposomal amphotericin B, fluconazole, and rifampicin-sparing antitubercular therapy. After showing clinical improvement, he was discharged with dual therapy and stabilized after 3 weeks of hospitalization. Our findings emphasize the importance of comprehensive clinical guidelines and multidisciplinary management to address the complexities of treating this co-infection. Our case review underscores the need for integrated diagnostic and therapeutic protocols, timing of initiation of ART, and comprehensive management strategies to improve outcomes for this vulnerable patient population.Item Brucellosis Presenting as Immune-mediated Thrombocytopenia in a Young Indian Male(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-09) Singh, J; Vadali, S; Badole, P.Brucellosis has previously been described to cause thrombocytopenia through various mechanisms, but an autoimmune phenomenon secondary to molecular mimicry has been infrequently reported in a handful of case reports. We present a case of a young male with no significant past medical history who presented with bleeding from his gums, the presence of black, tarry stools, petechial skin rashes, and epistaxis persisting over four weeks. Physical examination revealed pallor and splenomegaly. Preliminary investigations showed low red blood cells and platelet counts. A working diagnosis of immune thrombocytopenia (ITP) was made, and management was initiated with methylprednisolone and intravenous immunoglobulins; however, the platelet counts remained low despite the intervention. Further workup revealed increased megakaryocytes on bone marrow biopsy. Serum Brucella IgM was positive. Given this, doxycycline and gentamicin were initiated, resulting in marked improvement in cell counts after a week of therapy. Hence, a high clinical suspicion for brucellosis should be maintained in cases of isolated thrombocytopenia, especially in endemic areas.Item Persistent Candidemia in the Postpartum Period: A Case of Uterocutaneous Fistula and the Role of Dual Antifungal Therapy(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-09) Prakash, J; B, A; Sharma, T.Candidemia, the systemic spread of Candida spp, is a significant concern in intensive care units and among immunocompromised patients. This case report details a young postpartum female who developed persistent candidemia following a lower-segment cesarean section. Postoperatively, she experienced a high-grade fever, respiratory distress, and disorientation, initially managed with broad-spectrum antibiotics and later with antifungal therapy. Blood cultures confirmed Candida glabrata, and imaging revealed a likely �tero-cutaneous fistula as the infection source. Despite initial monotherapy, the patient showed no improvement, prompting the addition of a second antifungal agent. The dual regimen of caspofungin and voriconazole led to clinical improvement, and subsequent blood cultures were sterile. The patient was discharged on oral fluconazole. This case underscores the complexities of managing persistent candidemia, particularly in the postpartum period, and highlights the potential benefits of dual-antifungal therapy in refractory cases. Comprehensive imaging and a multidisciplinary approach were crucial in identifying and managing the uncommon source of infection. This report contributes to the limited literature on postpartum candidemia and emphasizes the need for thorough evaluation and tailored treatment strategies. Further research is needed to establish clear guidelines for using combination antifungal therapy in persistent candidemia and to explore the management of complex cases involving uncommon sources of infection.Item Non-tuberculous Mycobacteria Osteomyelitis of Patella with Prepatellar Bursitis of Knee(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-09) Garg, A; Aggarwal, A; Vishwajeet, V; Samantaray, STuberculosis has been persisting with mankind since time immemorial, which delineates its ubiquitous nature. However, infections with non-tuberculous mycobacteria of musculoskeletal tissue are rare. Though the knee joint is the third most common site of involvement after the spine and hip, atypical mycobacterial infection of the patella in an immunocompetent patient is unheard of. Herein, we present a case of a late adolescent male with diffuse painful swelling of the left knee, which came to be diagnosed as Non-tuberculous Mycobacteria osteomyelitis of the patella left side for its rarity and its successful management by antitubercular chemotherapy without any surgical intervention. High suspicion, early diagnosis and anti-NTM chemotherapy bring satisfactory outcomes.Item Secondary Hemophagocytic Lymphohistiocytosis in Enteric Fever - A Duo of Diagnostic Dilemmas(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-09) Das, D; Kumari, D; Panda, PKHemophagocytic lymphohistiocytosis (HLH) is a rapidly progressive inflammatory disorder associated with cytopenia, splenomegaly, cytokine overproduction and hyperferritinemia. It is a rare but potentially fatal disorder, particularly in developing countries like India, Bangladesh and Nepal, often associated with infections such as enteric fever. Recognising HLH is challenging due to nonspecific symptoms of fever, cytopenia, and organ dysfunction and requires prompt identification and aggressive treatment. Molecular confirmation or fulfilment of specific clinical parameters is often difficult in resource-limited settings in these South Asian countries. Here, we present two cases, one woman in her 30s and a man in his 40s, both diagnosed with secondary HLH linked to enteric fever, showcasing the diagnostic challenges. Despite constraints in molecular testing, clinical and laboratory criteria were met, supporting the importance of early antibiotic intervention and supportive care to mitigate the high mortality associated with secondary HLH.Item Implementation of a Clinical Pharmacology-Centric Antimicrobial Stewardship Initiative within COVID-19 Intensive Care Units at a Leading Tertiary Care Referral Center in India(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-09) Gamad, N; Bhattacharjee, S; Shafiq, N; Bhalla, A; Kajal, K; Bhagat, H; H, A; M, V; S, K; Singh, A; M, S; M, GK; G, R; B, NN; Saini, K; K, N; B, I; Verma, N; A, A; Singh, I; G, PDBackground: The importance of antimicrobial stewardship during the COVID-19 pandemic remains underreported. Methods: We prospectively audited antimicrobial use in COVID-19 ICUs of a tertiary care center from April 2021 to June 2021 during the delta wave of COVID-19 in India. Prospective audits and feedback (PAF) were conducted concurrently during case discussions on all days during this period. A summary of feedback, including empiric antibiotic rationality, de-escalation, etc., was mailed to all the treating physicians every day. Results: 161 out of 183 patients (87.97%) were empirically prescribed antimicrobials in COVID ICUs, with an average of three antimicrobials per patient. The most commonly prescribed empiric antibiotic was piperacillin-tazobactam, followed by ceftriaxone and colistin. De-escalation was suggested in 45.2% of prescriptions, which were followed in 36.5% but delayed in around 16% of suggestions. The presence of multiple comorbidities with intubation and/or shock was the most common reason for initiating and continuing empirical antimicrobials. Around 29.8% of the patients on antimicrobials developed MDR infections, and Acinetobacter baumannii was the most common organism isolated, with an average length of stay of 20 (19.6 days). Conclusion: Antimicrobial stewardship can play an essential role in minimizing the use of unnecessary antimicrobials in COVID-19 patients.Item 3-Step Model- An Explorative Novel Approach to Classify Sepsis: A Longitudinal Study(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-09) Pilania, J; Das, A; Panda, PK; Chauhan, UBackground: Sepsis remains a critical healthcare challenge worldwide, demanding prompt identification and treatment to improve patient outcomes. Given the absence of a definitive gold-standard diagnostic test, adjunct diagnostic tools are imperative to aid in early sepsis detection and guide effective treatment strategies. This study introduces a novel 3-step model to identify and classify sepsis, integrating current knowledge and clinical guidelines to enhance diagnostic precision. Methods: This longitudinal study was conducted at a tertiary care teaching hospital in northern India. Adult patients admitted with suspected sepsis underwent screening using predefined criteria. The 3-step model consisted of assessing dysregulated host response using a National Early Warning Score-2 (NEWS-2) score of ?6 (step 1); evaluating risk factors for infection (step 2); and assessing infection presence through clinical, supportive, or confirmatory evidence (step 3). Based on this Model, patients were categorized into asepsis, possible sepsis, probable sepsis, or confirmed sepsis at various intervals during hospitalization. Results: A total of 230 patients were included. Initial categorization on Day 1 showed 13.0% in asepsis, 35.2% in possible sepsis, 51.3% in probable sepsis, and 0.4% in confirmed sepsis. By Day 7, shifts were observed with 49.7% in asepsis, 9.5% in possible sepsis, 25.4% in probable sepsis, and 15.4% in confirmed sepsis. At discharge or death by day 28, categories were 60.4% asepsis, 5.2% possible sepsis, 21.7% probable sepsis, and 12.6% confirmed sepsis. Transitions between categories were noted throughout hospitalization, demonstrating the dynamic nature of sepsis progression and response to treatment. Conclusions: The 3-step Model effectively stratifies sepsis status over hospitalization, facilitating early identification and classification of septic patients. This approach holds promise for enhancing diagnostic accuracy, guiding clinical decision-making, and optimizing antimicrobial stewardship practices. Further validation across diverse patient cohorts and healthcare settings must confirm its utility and generalizability.Item Utilizing Direct MALDI TOF MS from Positive Blood Culture for Diagnosis of Anaerobic Bacteremia(Society for Antimicrobial Stewardship PractIces (SASPI), 2024-06) Padmanaban, H; Dash, D; Rai, SAnaerobic bacteraemia is a significant cause of morbidity and mortality among hospitalized patients worldwide. Early identification of these microorganisms from blood culture is pivotal in diagnosing and can improve treatment and outcomes. We present a case of anaerobic bacteraemia in a patient with diabetic foot ulcer, which was detected rapidly by the Matrix Assisted Laser Desorption Ionization Time of Flight (MALDI-TOF) from a positive blood culture bottle in a laboratory setting with minimal facilities for anaerobic culture methods.