Retrospective registry study finds high antimicrobial use in nine Indian intensive care units

A retrospective registry-based descriptive study found that antimicrobial use was high across nine intensive care units in India, with broad-spectrum treatment from the day of admission and simultaneous use of multiple antimicrobials reported as common. The study assessed data collected by the participating ICUs over three months through the Indian Registry of IntenSive care, or IRIS. The abstract reported that 71.1% of 2,450 ICU admissions involved at least one antimicrobial at some point during the ICU stay.

The researchers calculated antimicrobial utilisation as days of therapy per 1,000 patient days and the antimicrobial prescribing rate per 1,000 patients. Across the three-month assessment period, the registry recorded 682.5 days of therapy per 1,000 patient days and an antimicrobial prescribing rate of 1,226.9 per 1,000 patients. These measures summarise the volume and frequency of recorded antimicrobial treatment; they do not represent the proportion of individual patients treated or the number of treatment courses. The investigators also examined whether recorded prescribing was concordant with recommended therapy.

ICU-specific antimicrobial prescribing guidelines were available at six of the nine participating sites. The researchers appraised the guidelines with the International Centre for Allied Health Evidence framework, known as iCAHE. Guideline quality scores ranged from 7% to 64%. The study therefore identified variation in the availability and assessed quality of local prescribing guidance, although the abstract did not provide site-level scores or further details about the appraisal.

Several limitations constrain interpretation of the findings. Culture rates were likely underreported, missing daily data hindered assessment of prescribing appropriateness, and the reported data covered only three months at nine ICUs. The results describe the participating units during the assessment period and were not presented as evidence of trends over time, differences between regions, or causal effects of particular prescribing practices. The authors concluded that the findings show a high dependency on broad-spectrum antimicrobial management in Indian ICUs. They also proposed that registry systems such as IRIS could support benchmarking of antimicrobial utilisation and stewardship interventions, while noting that gaps in data completeness need to be addressed. These are potential applications of the registry, not tested outcomes of an intervention.

Subject of Research: Antimicrobial utilisation and prescribing guidance in nine Indian intensive care units

Article Title: Antimicrobial utilisation across intensive care units in India: a retrospective registry-based descriptive study

Article References: Arfin, S., Rashan, A., Tirupakuzhi Vijayaraghavan, B. K., Jayakumar, D., Mathew, M., Savio, R. D., Kooloth, R. A., Tripathy, S., Shukla, U., Jha, V., Haniffa, R., Beane, A., & Dongelmans, D. A. (2026). Antimicrobial utilisation across intensive care units in India: a retrospective registry-based descriptive study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15691-9

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DOI: 10.1186/s12913-026-15691-9

Keywords: antimicrobial utilisation, antimicrobial prescribing, intensive care units, India, IRIS registry, days of therapy, broad-spectrum antimicrobials, antimicrobial stewardship, clinical guidelines, Antimicrobial, utilisation, across