Clinical and Economic Outcomes from the Implementation of Hospital-based Antimicrobial Stewardship Programs: A Systematic Review and Meta-Analysis.
Antimicrob Agents Chemother. 2016 May 31;
Authors: Karanika S, Paudel S, Grigoras C, Kalbasi A, Mylonakis E
BACKGROUND: The implementation of Antimicrobial Stewardship Programs (ASPs) is a promising strategy to help address the problem of antimicrobial resistance.
OBJECTIVES: We aimed to determine the efficacy of ASPs and their effect on clinical and economic parameters.
SEARCH STRATEGY/SELECTION CRITERIA: We searched PubMed, EMBASE and Google Scholar looking for studies on efficacy of ASPs in hospitals.
MAIN RESULTS: Based on 26 studies (extracted from 24,917 citations) with pre- and post-implementation periods from 6 months to 3 years, the pooled percentage change of total antimicrobial consumption after the implementation of ASPs was -19.1%[95%CI(-30.1,-7.5)] and the use of restricted antimicrobial agents decreased by -26.6%[95%CI(-52.3,-0.8)]. Interestingly, in ICUs the decrease in antimicrobial consumption was -39.5%[95%CI(-72.5,-6.4)]. The use of broad-spectrum antibiotics [-18.5%,95%CI(-32,-5.0) for carbapenems, -14.7%,95%CI(-27.7,-1.7) for glycopeptides], the overall antimicrobial cost [-33.9%,95%CI(-42.0,-25.9)] and the hospital length of stay [-8.9%,95%CI(-12.8,-5)] decreased. Among hospital pathogens, implementation of ASPs was associated with decrease of infections due to methicillin-resistant Staphylococcus aureus [RD=-0.017,95%CI(-0.029,-0.005)], imipenem-resistant Pseudomonas aeruginosa [RD=-0.079,95%CI(-0.114,-0.040)] and extensive-spectrum beta-lactamase Klebsiella spp. [RD=-0.104,95%CI,(-0.153,-0.055)]. Notably, these improvements were not associated with adverse outcomes, as all-cause, infection-related 30-day mortality and infection rates were not significantly different after implementation of an ASP [RD=-0.001,95%CI(-0.009,0.006),RD=-0.005,95%CI(-0.016,0.007),-0.045%,95%CI(-0.241,0.150), respectively].
AUTHOR'S CONCLUSIONS: Hospital ASPs result in significant decrease 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.
PMID: 27246783 [PubMed - as supplied by publisher]