Research needs in antibiotic stewardship

Morris, Andrew M.; Calderwood, Michael S.; Fridkin, Scott K.; Livorsi, Daniel J; McGregor, Jessina C.; Mody, Lona; Moehring, Rebekah W.; Pakyz, Amy; Stenehjem, Edward; Szymczak, Julia E.

doi:10.1017/ice.2019.276

Cited by 32 publications

(20 citation statements)

References 135 publications

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“…To address this crisis, numerous national and international bodies have begun developing policy to control antibiotic use and funding research aimed at identifying and targeting drivers of resistance [3,5]. However, we still have an incomplete understanding of the factors beyond antibiotic consumption that influence the distribution and spread of antibiotic resistance in human populations [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Rates of increase of antibiotic resistance and ambient temperature in Europe: a cross-national analysis of 28 countries between 2000 and 2016

McGough

MacFadden

Hattab³

et al. 2020

Eurosurveillance

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Background The rapid increase of bacterial antibiotic resistance could soon render our most effective method to address infections obsolete. Factors influencing pathogen resistance prevalence in human populations remain poorly described, though temperature is known to contribute to mechanisms of spread. Aim To quantify the role of temperature, spatially and temporally, as a mechanistic modulator of transmission of antibiotic resistant microbes. Methods An ecologic analysis was performed on country-level antibiotic resistance prevalence in three common bacterial pathogens across 28 European countries, collectively representing over 4 million tested isolates. Associations of minimum temperature and other predictors with change in antibiotic resistance rates over 17 years (2000–2016) were evaluated with multivariable models. The effects of predictors on the antibiotic resistance rate change across geographies were quantified. Results During 2000–2016, for Escherichia coli and Klebsiella pneumoniae, European countries with 10°C warmer ambient minimum temperatures compared to others, experienced more rapid resistance increases across all antibiotic classes. Increases ranged between 0.33%/year (95% CI: 0.2 to 0.5) and 1.2%/year (95% CI: 0.4 to 1.9), even after accounting for recognised resistance drivers including antibiotic consumption and population density. For Staphylococcus aureus a decreasing relationship of −0.4%/year (95% CI: −0.7 to 0.0) was found for meticillin resistance, reflecting widespread declines in meticillin-resistant S. aureus across Europe over the study period. Conclusion We found evidence of a long-term effect of ambient minimum temperature on antibiotic resistance rate increases in Europe. Ambient temperature might considerably influence antibiotic resistance growth rates, and explain geographic differences observed in cross-sectional studies. Rising temperatures globally may hasten resistance spread, complicating mitigation efforts.

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Section: Introductionmentioning

confidence: 99%

Rates of increase of antibiotic resistance and ambient temperature in Europe: a cross-national analysis of 28 countries between 2000 and 2016

McGough

MacFadden

Hattab³

et al. 2020

Eurosurveillance

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“…Meaningful benchmarking of antibiotic use across facilities will likely require some degree of risk adjustment, which could include both patient level and hospital level factors. 4 In this study, we found an association between MRSA prevalence at admission among a hospitalized population and that hospital's use of anti-MRSA antibiotics. Although this association was statistically significant, it was relatively small in magnitude.…”

Section: Discussionmentioning

confidence: 59%

MRSA prevalence and hospital-level antibiotic use: A retrospective study across 122 acute-care hospitals

Livorsi

Nair

Lund

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…Three recent, excellent reviews have also defined pressing research need within the field. 45,178,190 It is likely that novel scientific findings, for instance regarding the complex dynamic between use and resistance, 191–194 and the application of clinical support systems in treatment decisions based on artificial intelligence, 195–197 will affect the way we perform antimicrobial stewardship in the not so distant future. It is clear that antimicrobial stewardship has come a long way since the start more than 20 years ago, but also clear that a combination of globally coordinated and locally adjusted efforts are needed to achieve even better impact.…”

Section: Conclusion and Future Aspectsmentioning

confidence: 99%

Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy Part I: step-wise design of an antimicrobial stewardship program

Resman

2020

Therapeutic Advances in Infection

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Regardless of one’s opinion of antimicrobial stewardship programs (ASPs), it is hardly possible to work in hospital care and not be exposed to the term or its practical effects. Despite the term being relatively new, the number of publications in the field is vast, including several excellent reviews of general and specific aspects. Work in antimicrobial stewardship is complex, and includes not only aspects of infectious disease and microbiology, but also of epidemiology, genetics, behavioural psychology, systems science, economics and ethics, to name a few. This review aims to take several of these aspects and the scientific evidence of antimicrobial stewardship studies and merge them into two questions: How should we design ASPs based on what we know today? And which are the most essential unanswered questions regarding antimicrobial stewardship on a broader scale? This narrative review is written in two separate parts aiming to provide answers to the two questions. This first part is written as a step-wise approach to designing a stewardship intervention based on the pillars of unmet need, feasibility, scientific evidence and necessary core elements. It is written mainly as a guide to someone new to the field. It is sorted into five distinct steps: (a) focusing on designing aims; (b) assessing performance and local barriers to rational antimicrobial use; (c) deciding on intervention technique; (d) practical, tailored design including core element inclusion; and (e) evaluation and sustainability. The second part, published separately, formulates ten critical questions on controversies in the field of antimicrobial stewardship. It is aimed at clinicians and researchers with stewardship experience and strives to promote discussion, not to provide answers.

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Research needs in antibiotic stewardship

Cited by 32 publications

References 135 publications

Rates of increase of antibiotic resistance and ambient temperature in Europe: a cross-national analysis of 28 countries between 2000 and 2016

Rates of increase of antibiotic resistance and ambient temperature in Europe: a cross-national analysis of 28 countries between 2000 and 2016

MRSA prevalence and hospital-level antibiotic use: A retrospective study across 122 acute-care hospitals

Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy Part I: step-wise design of an antimicrobial stewardship program

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