TEMPORAL TRENDS IN MULTIDRUG-RESISTANT ORGANISMS AND ANTIMICROBIAL RESISTANCE RATES FOLLOWING IMPLEMENTATION OF AN ANTIMICROBIAL STEWARDSHIP PROGRAM: A 17-MONTH SURVEILLANCE STUDY FROM A TERTIARY CARE HOSPITAL IN JAIPUR, INDIA

Background: Multidrug-resistant organisms (MDROs) are a growing threat to patient safety in tertiary care hospitals, particularly in intensive care units (ICUs). Antimicrobial stewardship programs (ASPs) are recommended to curb the emergence and spread of resistance, but sustained facility-level surveillance data from Indian hospitals demonstrating temporal impact remain limited.
Methods: We conducted a retrospective, descriptive surveillance study of clinical microbiology culture and sensitivity (C&S) records at a tertiary care hospital in Jaipur, India, spanning March 2025 to July 2026 (17 months), during ongoing implementation of an antimicrobial stewardship program. Monthly counts of total clinical isolates and MDROs were extracted, and organism-, specimen-, and location-wise distributions of individual MDRO isolates were tabulated. The monthly antimicrobial resistance (AMR) rate was defined as (MDRO isolates / total clinical isolates) × 100. Temporal trend was assessed by simple linear regression and Pearson correlation; the pre- and post-midpoint periods were compared using the chi-square test. A two-tailed p-value <0.05 was considered statistically significant.
Results: Of 770 culture and sensitivity requests processed, 192 (24.9%) yielded a clinically significant isolate, of which 59 (30.7%) were MDROs. Sixty individual MDRO isolates were characterized on line-listing; Klebsiella pneumoniae (28.3%) and Pseudomonas aeruginosa (23.3%) were the predominant organisms, followed by Escherichia coli (13.3%) and Enterobacter cloacae complex (11.7%). MDROs were most frequently isolated from urine (30.0%) and pus (28.3%) specimens and originated predominantly from general wards (51.7%) and ICUs (40.0%). The monthly AMR rate declined significantly over the surveillance period (Pearson r = −0.51, R² = 0.26, linear regression slope = −1.93% per month, t(15) = −2.30, p = 0.036). The mean AMR rate fell from 34.8% in the first 12 months (Mar 2025–Feb 2026) to 21.1% in the final 5 months (Mar–Jul 2026), a difference that approached statistical significance (χ² = 3.57, df = 1, p = 0.059).
Conclusion: A statistically significant downward trend in monthly antimicrobial resistance rate was observed over the surveillance period, coinciding with sustained antimicrobial stewardship activity. Klebsiella pneumoniae and Pseudomonas aeruginosa, both WHO critical-priority pathogens, dominated the MDRO burden, with wards and ICUs contributing over 90% of isolates. These findings support continued, targeted stewardship and infection-control efforts, with periodic surveillance-based feedback.