Challenges in implementing antimicrobial stewardship (AMS) in organ transplant centers in India.

INTRODUCTION: We, in India, have unique challenges in implementing antimicrobial stewardship (AMS) in our institutions, especially the transplant settings. Identifying challenges, addressing them, and finding innovative solutions to these are the need of the hour.

CHALLENGES: Several challenges in India exists, which hamper implementation of effective AMS like lack of adequately trained personnel (infectious diseases [ID] physicians and clinical pharmacists), missing opportunities of AMS during the timeline, and lack of India-specific outcome measures for AMS programme.

SOLUTIONS: Finding local solutions can make our AMS implementation more effective. Numbers of ID physicians are increasing (24 in 2011 to >300 in 2020), and we expect the specialty to grow more and make rapid progress in AMS. We propose that cost savings and overall improvement in clinical outcome to be included in outcomes measures, rather than rates of C. difficle infection. Effective implementations of National Medical Commission mandatory AMS training regulation are few such steps that can fill the gaps.

CONCLUSION: Antimicrobial stewardship programs is one of the several components of tackling the antimicrobial resistance-related negative consequences in transplant patients. Transplant physicians, surgeons, and institutions should understand the bigger picture and strive hard to convince the policymakers to act for the benefit of the transplant recipients and the transplant programs across the country.