Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review

Abstract

BackgroundHospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of antimicrobials to combat antimicrobial resistance. For ASPs to be developed, adopted, and implemented, an economic value assessment is essential. Few studies demonstrate the cost-effectiveness of ASPs. This systematic review aimed to evaluate the economic and clinical impact of ASPs.MethodsAn update to the Dik et al. systematic review (2000–2014) was conducted on EMBASE and Medline using PRISMA guidelines. The updated search was limited to primary research studies in English (30 September 2014–31 December 2017) that evaluated patient and/or economic outcomes after implementation of hospital ASPs including length of stay (LOS), antimicrobial use, and total (including operational and implementation) costs.ResultsOne hundred forty-six studies meeting inclusion criteria were included. The majority of these studies were conducted within the last 5 years in North America (49%), Europe (25%), and Asia (14%), with few studies conducted in Africa (3%), South America (3%), and Australia (3%). Most studies were conducted in hospitals with 500–1000 beds and evaluated LOS and change in antibiotic expenditure, the majority of which showed a decrease in LOS (85%) and antibiotic expenditure (92%). The mean cost-savings varied by hospital size and region after implementation of ASPs. Average cost savings in US studies were $732 per patient (range: $2.50 to $2640), with similar trends exhibited in European studies. The key driver of cost savings was from reduction in LOS. Savings were higher among hospitals with comprehensive ASPs which included therapy review and antibiotic restrictions.ConclusionsOur data indicates that hospital ASPs have significant value with beneficial clinical and economic impacts. More robust published data is required in terms of implementation, LOS, and overall costs so that decision-makers can make a stronger case for investing in ASPs, considering competing priorities. Such data on ASPs in lower- and middle-income countries is limited and requires urgent attention.

Half of Prescribed Antibiotics Are Not Needed: A Pharmacist-Led Antimicrobial Stewardship Intervention and Clinical Outcomes in a Referral Hospital in Ethiopia

“…The tremendous variability inherent in many studies on antimicrobial stewardship limits interpretation of mortality benefits attributable to specific interventions (4,(20)(21)(22), but pharmacist-led interventions in China and in Brazil have been associated with a 10% reduction in mortality (23,24). In our study, all cause in-hospital mortality was 2-fold higher post-intervention compared to the intervention phase.…”

High Rates of Multi-Drug Resistant Gram-Negative Organisms Associated With Surgical Site Infections in a Teaching Hospital in Ghana

“…Hospital-based antimicrobial stewardship programs are said to decrease antibiotic use, though data on this is limited in low-and middle-income countries 24 .…”

Implementation of Antimicrobial Stewardship Measures in Cardiac Surgery: Change of Protocol for Surgical Antibiotic Prophylaxis and Its Impact on Surgical Site Infections

“…17,18 We know ASP works but we also know that changing behavior remains a challenge. 19,20,21 Regarding all guidelines, meta-analyses, the international literature and the results of this retrospective observational study we can reason that a change of antimicrobial choice from Cefuroxime to Cefazolin as a perioperative antibiotic prophylaxis in cardiac surgery might not increase the rates of overall wound infections, including deep sternal wound infections as well as leg infections.…”