Results of a Local Antibiotic Management Program on Antibiotic Use in a Tertiary Intensive Care Unit in Hungary

Pető, Zoltán; Benkő, Ria; Matuz, Mária; Csullog, Emese; Molnár, Andrea; Hajdú, Edit

doi:10.1007/s15010-008-7377-8

Cited by 41 publications

(30 citation statements)

References 44 publications

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“…Stratifying the studies per hospital setting, we found that studies conducted in medical wards achieved an antimicrobial reduction of Ϫ12.1% (95% CI ϭ Ϫ19.9 to Ϫ4.3%, 2 ϭ 0.00) (37,40,43,51), whereas the studies conducted in an ICU reached a decrease of Ϫ39.5% (95% CI ϭ Ϫ72.5 to Ϫ6.4, 2 ϭ 0.13) (31,33,45,47), with no small-study effect (Egger's bias ϭ Ϫ0.2, P ϭ 0.823) based on four studies. This difference between medical wards and the critical care setting was Ϫ27% and was statistically significant (95% CI ϭ Ϫ72.3 to Ϫ5.5) (Fig.…”

Section: Resultsmentioning

confidence: 93%

“…Studies conducted in the United States (30,(34)(35)(36) and in Europe (29,33,(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) reported the highest pooled decrease in antimicrobial consumption after the implementation of ASP (Ϫ19.9% [95% CI ϭ Ϫ27.7 to Ϫ12.1, 2 ϭ 0.00] and Ϫ20.9% [95% CI ϭ Ϫ30.5 to Ϫ15, 2 ϭ 0.05], respectively), whereas studies in Asia reported a reduction of Ϫ16% (95% CI ϭ Ϫ36.5 to Ϫ5.3], 2 ϭ 0.11) (28, 31, 32, 47-52) (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

“…Evaluation of ASPs is based on their performance on antimicrobial consumption, as well as on clinical and microbiological outcomes and cost-effectiveness (45). However, because ASPs are highly variable, establishing specific targets and performance criteria requires the synthesis of data from different settings, making this topic ideal for a meta-analysis study.…”

Section: Discussionmentioning

confidence: 99%

“…August 2016 Volume 60 Number 8 aac.asm.org 4845 Antimicrobial Agents and Chemotherapy on May 12, 2018 by guest http://aac.asm.org/ Downloaded from change significantly after implementation of an ASP based on four studies (1.5%, 95% CI ϭ Ϫ16.8 to 19.9, Egger's bias ϭ 2.57, P ϭ 0.080) (31,33,45,47).…”

Section: Antimicrobial Stewardship In Hospitalsmentioning

confidence: 99%

“…Evaluating the effect on the prevalence of resistant strains derived from infections, methicillin-resistant Staphylococcus aureus (MRSA) infections were significantly lower after the implementation of the ASP based on six studies with follow-up period of 1 year (33, 42, 48) or 2 years (35, 45, 52) (pooled RD ϭ Ϫ0.017, 95% CI ϭ Ϫ0.029 to Ϫ0.005, 2 ϭ 0.03, [Egger's bias ϭ Ϫ1.25, P ϭ 0.280) (33,35,42,45,48,52), and the same was noted for imipenem-resistant Pseudomonas aeruginosa based on five studies with follow-up period of 1 year (33, 42) or 2 years (30, 35, 45, 52) (pooled RD ϭ Ϫ0.079, 95% CI ϭ Ϫ0.114 to Ϫ0.04, 2 ϭ 0.03, Egger's bias ϭ Ϫ0.11, P ϭ 0.918) (30,33,35,45,52) and infections associated with extended-spectrum beta-lactamase (ESBL)-Klebsiella spp. based on five studies with follow-up period of 1 year (33, 42, 48) or 2 years (35, 45) (pooled RD ϭ Ϫ0.104, 95% CI ϭ Ϫ0.153 to Ϫ0.055, 2 ϭ 0.02, Egger's bias ϭ 1.53, P ϭ 0.225) (33,35,42,45,48), whereas a significant decrease was not observed in ESBL-Escherichia coli infections based on five studies with follow-up period of 1 year (33, 42, 48) or 2 years (35, 45) (pooled RD ϭ Ϫ0.009, 95% CI ϭ Ϫ0.044 to 0.055], 2 ϭ 0.02, Egger's bias ϭ Ϫ0.65, P ϭ 0.560) (33,35,42,45,48) (see Fig. S7, S8, and S9 in the supplemental material).…”

Section: Antimicrobial Stewardship In Hospitalsmentioning

confidence: 99%

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Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

Karanika

Paudel

Grigoras

et al. 2016

Antimicrob Agents Chemother

308

192

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bThe implementation of antimicrobial stewardship programs (ASPs) is a promising strategy to help address the problem of antimicrobial resistance. We sought to determine the efficacy of ASPs and their effect on clinical and economic parameters. We searched PubMed, EMBASE, and Google Scholar looking for studies on the efficacy of ASPs in hospitals. Based on 26 studies (extracted from 24,917 citations) with pre-and postimplementation periods from 6 months to 3 years, the pooled percentage change of total antimicrobial consumption after the implementation of ASPs was ؊19.1% (95% confidence interval [CI] ‫؍‬ ؊30.1 to ؊7.5), and the use of restricted antimicrobial agents decreased by ؊26.6% (95% CI ‫؍‬ ؊52.3 to ؊0.8). Interestingly, in intensive care units, the decrease in antimicrobial consumption was ؊39.5% (95% CI ‫؍‬ ؊72.5 to ؊6.4). ). Hospital ASPs result in significant decreases in antimicrobial consumption and cost, and the benefit is higher in the critical care setting. Infections due to specific antimicrobial-resistant pathogens and the overall hospital length of stay are improved as well. Future studies should focus on the sustainability of these outcomes and evaluate potential beneficial long-term effects of ASPs in mortality and infection rates.A bout one-third of the hospitalized patients and more than two-thirds of critically ill patients are on antimicrobial therapy at any time (1, 2), and up to half of antibiotic prescriptions are inappropriate or not necessary (3). In 2013, the Centers for Disease Control and Prevention (CDC) reported that about 2 million patients are infected yearly with antimicrobialresistant organisms in the United States, and about 23,000 deaths are directly attributed to these infections (3). This resulted in a call to action for acute care hospitals to implement antimicrobial stewardship programs (ASPs) (4, 5), a term that is used to describe the integrated strategy of improving antimicrobial use in order to enhance patient outcomes, reduce antimicrobial cost, and minimize the side effects associated with antimicrobial use, including drug resistance and nosocomial infections (4, 6, 7). Although there are studies that have already presented data on the efficacy of ASPs in the inpatient setting (8-10), limitations compromise their generalization (i.e., the studies were only conducted in the United States [8], age and study design limitations [9], a lack of clinical outcomes [10], etc.). The purpose of our systematic review and meta-analysis was to measure the efficacy of the implementation of an ASP expressed in daily defined doses (DDD) per 1,000 patient days in the hospital setting independently of the age and study design and to assess the subsequent clinical and economic outcomes. MATERIALS AND METHODSThis systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol (11).Search strategy. A systematic electronic search of PubMed, EMBASE, and Google Scholar databases was performed for pertinent studies up t...

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