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

Abstract

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...

Impact of clinical pharmacist intervention on antimicrobial use in a small 164-bed hospital

“…Antimicrobial stewardship programmes (ASPs) are a promising strategy for dealing with AMR 5. An ASP is defined as an ongoing effort by a healthcare institution to optimise antimicrobial use by hospitalised patients in order to improve patient outcomes, reduce adverse events associated with antimicrobial use (including AMR) and ensure cost-effective treatment 6.…”

Preventing the Post-Antibiotic Era by Training Future Pharmacists as Antimicrobial Stewards

“…5 Multiple professional organizations have issued recommendations for the widespread adoption of ASPs with pharmacists as essential members of an interprofessional team, including the Infectious Diseases Society of America 6,7 , the Society for Healthcare Epidemiology of America 6,7 , the Society of Infectious Diseases Pharmacists 7 , and the American Society of Health-systems Pharmacists 7,8 . In addition, the Centers for Disease Control and Prevention (CDC) included the need for "drug expertise" provided by a "pharmacy leader" as a one of the core elements in their "Core Elements of Hospital Antimicrobial Stewardship Programs" guidance.…”

Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions

“…Given the existing evidence of the effectiveness of ASPs [2,3] in reducing inappropriate antibiotic use, regulatory and accreditation bodies have either approved or proposed requiring that all hospitals have ASPs in place, regardless of size or critical access designation of the facilities [4,5]. A significant portion of US healthcare takes place in small hospitals.…”