Antibiotic stewardship: does it work in hospital practice? A review of the evidence base.

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Antibiotic stewardship: does it work in hospital practice? A review of the evidence base.

Clin Microbiol Infect. 2017 Jul 24;:

Authors: Hulscher MEJL, Prins JM

Abstract
BACKGROUND: Guidelines for developing and implementing stewardship programmes include recommendations on 'appropriate antibiotic use' to guide the stewardship team's choice of potential stewardship objectives. They also include recommendations on 'behavioural change interventions' to guide the team's choice of potential interventions to ensure that professionals actually use antibiotics appropriately in daily practice.
AIMS: This paper aims to summarize the evidence base of both appropriate antibiotic use recommendations (the "what") and behavioural change interventions (the "how") in hospital practice.
SOURCES: Published systematic reviews/Medline.
CONTENT: The literature shows low quality evidence of the positive effects of appropriate antibiotic use in hospital patients. The literature shows that any behavioural change intervention might work to ensure that professionals actually perform appropriate antibiotic use recommendations in daily practice. Although effects were overall positive, there were large differences in improvement between studies that tested similar change interventions.
IMPLICATIONS: The literature showed the clear need for studies that apply appropriate study designs -(randomized) controlled designs-to test the effectiveness of appropriate antibiotic use on achieving meaningful outcomes. Most current studies used designs prone to confounding by indication. In the process of selecting behavioural change interventions that might work best in a chosen setting, much should be learned from behavioural sciences. The challenge for stewardship teams lies in selecting change interventions on the careful assessment of barriers and facilitators, and on a theoretical base while linking determinants to change interventions. Future studies should apply more robust designs and evaluations when assessing behavioural change interventions.

PMID: 28750920 [PubMed - as supplied by publisher]

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