Baseline Assessment of Antimicrobial Use and Stewardship Gaps in a Tertiary Care Hospital in South India: A Point Prevalence Audit

Background: Antimicrobial resistance is a major global public health concern, with a disproportionate burden in low- and middle-income countries. In hospital settings, inappropriate antimicrobial use, particularly excessive empirical and broad-spectrum prescribing, remains a key driver of resistance. Reliable baseline data on prescribing practices are essential for guiding antimicrobial stewardship interventions. Point prevalence surveys offer a standardized, resource-efficient method for assessing antimicrobial use. Yet, data from tertiary care hospitals in South India, particularly across both adult and pediatric services, remain limited. Aim: To assess the point prevalence of antimicrobial prescribing and identify key stewardship gaps across adult and pediatric inpatient services in a tertiary care teaching hospital in South India. Materials and Methods: A cross-sectional observational point prevalence survey was conducted in selected medicine and pediatric wards and intensive care units (ICUs). All eligible inpatients present on the survey days were included, excluding day-care admissions. The data were collected using a predesigned questionnaire adapted from the National Centre for Disease Control framework and were analyzed descriptively. Results: A total of 348 patients were surveyed, including 300 adults and 48 pediatric patients. Antimicrobial use varied substantially between wards and ICUs. In adult medicine wards, 29.5% of patients received antimicrobials, increasing to 75% in the medical ICU. Ceftriaxone was the most frequently prescribed agent in wards, while piperacillin–tazobactam predominated in the ICU. Pediatric antimicrobial use was 38.1% in wards and 83.3% in the pediatric ICU, with ampicillin being the most commonly prescribed agent. Empirical therapy predominated across all clinical settings. Culture-guided treatment was documented in only 6 of 115 patients (5.2%) receiving antimicrobials. Conclusion: This point prevalence survey-based audit provides baseline data on antimicrobial prescribing and identifies important stewardship gaps, including high empirical use and limited culture-guided therapy. Point prevalence survey methodology represents a feasible approach for informing antimicrobial stewardship strategies in resource-constrained tertiary care settings.