Antibiotics resistance and mitigation strategies in healthcare settings: A scoping review

Abstract

<jats:p>Background: According to the European Center for Disease Prevention and Control (ECDC), the EU records an estimated 3.2 million healthcare associated infections (HAIs) and an associated 37,000 deaths annually. A significant proportion of the HAIs burden is attributable to multi-drug resistant pathogens. Infectious diseases remain top on the list of the leading causes of death globally with multi-drug resistant microorganisms (MDROs) playing a significant role. Aims: To assess the breadth of studies on antibiotics stewardship C. diff and Klebsiella pneumoniae in healthcare settings. To identify existing literature on the interventions for reducing healthcare associated C. diff and Klebsiella pneumoniae transmission. Methods: This scoping review was undertaken and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines. The specific databases searched included MEDLINE, PubMed, Web of Science Core Collection, and CINAHL. The process for screening articles and data extraction was undertaken in duplicate by two reviewers. A narrative synthesis of the results is provided. Results: The review included 34 studies (16 studies on Clostridium difficile and 18 articles focussed on Klebsiella pneumoniae). These interventions include Education, Surveillance/Screening, Consultations, Audits, Policies/Protocols, Environmental disinfection, Bundles, Isolation, and Notifications or alerts (ESCAPE-BIN). A study involving screening, alerts, staff education, and antimicrobial protocols recorded a 75% reduction in the use of targeted antimicrobials. The largest absolute reduction in antimicrobial use of 310 DDs/1000PDs was reported from an intervention that involved audits and feedback systems. The highest improvement (95%) in adherence was reported by an intervention involving the use of an infection prevention bundle and an environmental cleaning protocol. Conclusion: Antimicrobial resistance represents a global threat requiring urgent measures to protect lives. Reducing the burden of AMR entails a host of multi-level approaches aimed at curbing transmission of the resistant pathogens, and optimizing the use of antibiotics.</jats:p>