The quality of studies evaluating antimicrobial stewardship interventions: a systematic review

Schweitzer, Valentijn; Heijl, Inger van; Werkhoven, Cornelis H. van; Islam, Jasmin; Hendriks-Spoor, K.D.; Bielicki, Julia; Bonten, Marc J. M.; Walker, A. Sarah; Llewelyn, Martin J.; Harbarth, Stéphan Juergen; Huttner, Benedikt; Little, Paul; Rodríguez‐Baño, Jesús; Savoldi, Alessia; Smeden, Maarten van; Tacconelli, Evelina; Timsit, JF; Wolkewitz, Martin

doi:10.1016/j.cmi.2018.11.002

Cited by 53 publications

(53 citation statements)

References 25 publications

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“…It is interesting to notice that the relative number of articles on pediatric ASPs published in Europe and Asia increased between 2016 and 2018, compared to USA where the spike was already observed in 2013-2015. Moreover, there seems to be an ASPs research gaps in certain area of the world, mostly in middle-low or low income countries, that could be due to the fact that [156] found that the overall quality of ASPs studies is low and has not improved over time. Our research confirmed these previous finding with most of the studies having a beforeand-after design, most likely because of the low cost, convenience, and simplicity of these designs.…”

Section: Main Findingsmentioning

confidence: 99%

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

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Background: Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods: MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results: Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions: Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.

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Section: Main Findingsmentioning

confidence: 99%

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

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“…The analysis of the literature shows that the evaluation of the impact of these strategies suffers from several pitfalls concerning (i) the methodological quality of the studies and (ii) the indicators used to evaluate the impact of the interventions on human, animal and environmental health, including the J o u r n a l P r e -p r o o f 5 effect on the microbiota. In human, a recent review on the impact of antibiotic stewardship programmes in community and hospital settings thus showed the existence of numerous methodological biases in most published studies [5]: no randomisation, mainly single centre studies , retrospective with few evaluations of the clinical, or medico-economic impact. Moreover, very little attention has been given to the contribution of behavioural change strategies [6,7] and of the role of artificial intelligence in this domain to date.…”

Section: Discussionmentioning

confidence: 99%

“…In human, a recent review on the impact of antibiotic stewardship programmes in community and hospital settings thus showed the existence of numerous methodological biases in most published studies [5]: no randomisation, mainly single centre studies , retrospective with few evaluations of the clinical, or medico-economic impact. Moreover, very little attention has been given to the contribution of behavioural change strategies [6,7] and of the role of artificial intelligence in this domain to date. The use of artificial intelligence tools would enable the development of therapeutic decision support algorithms or, in animals, the supervision of livestock to provide prompt detection of infections and thus reduce the number of animals requiring treatment.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic resistance: Tools for effective translational research

et al. 2020

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“…First, this is a single-center study in Japan, and thus, it is uncertain whether our hospital-based ASP strategy can be applicable worldwide. Schweitzer et al described that only 48% and 23% of studies evaluating antimicrobial stewardship interventions reported clinical and microbiological outcomes, respectively [21]. However, we evaluated these outcomes, and it is noteworthy that our ASP strategy led to a decrease in carbapenem consumption with prescribing behavior change in a resource-limited setting.…”

Section: Discussionmentioning

confidence: 94%

Impact of an Infectious Disease Specialist-Led Postprescription Carbapenem Intervention on Prescribing Behavior in a Japanese Tertiary Hospital: a Before-After Study

Matono¹,

Umeda²,

Uchida³

et al. 2020

Preprint

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Background: There are a few infectious disease (ID) specialists in Japan. A solution to promote the implementation of antimicrobial stewardship activities under these resource-limited settings is required.Methods: We compared carbapenem consumption between a 24-month baseline and 12-month intervention periods. During the intervention period, an ID specialist provided daily advises through a chart review and ID consultation service to prescribers against all prolonged carbapenem use (≥ 14 days). Additionally, we send an aggregated table containing the weekly point prevalence amount of each departmental carbapenem use for 7–13 and ≥ 14 days through e-mail to all doctors.Results: Among the 1,241 carbapenem courses during the intervention period, the ID specialist provided a total of 96 instances of feedback regarding carbapenem use for ≥ 14 days, and the feedback acceptance rate was 76%. After the initiation of the intervention, the trend in monthly carbapenem consumption changed (coefficient: -0.62; 95% CI: -1.15 to -0.087, p = 0.024), and its consumption decreased (coefficient: -0.098; 95% CI: -0.16 to -0.039, p = 0.002) without an increase in the consumption of broad-spectrum antimicrobials or in-hospital mortality. Interestingly, the monthly number of carbapenem courses, but not the duration of carbapenem use, significantly decreased (coefficient: -3.02; 95% CI: -4.63 to -1.42, p = 0.001). The carbapenem-related annual estimated savings after the intervention was $83,745, with a 22% cost reduction.Conclusions: Our ID specialist-led daily intervention with weekly feedback regarding long-term carbapenem use was effective in reducing antimicrobial consumption. Such feedback may be useful in changing the prescribing behavior and promoting appropriate antimicrobial usage even in resource-limited settings.

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The quality of studies evaluating antimicrobial stewardship interventions: a systematic review

Cited by 53 publications

References 25 publications

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Antibiotic resistance: Tools for effective translational research

Impact of an Infectious Disease Specialist-Led Postprescription Carbapenem Intervention on Prescribing Behavior in a Japanese Tertiary Hospital: a Before-After Study

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