Leandro G Bertollo1, Diego S Lutkemeyer2, Anna S Levin2. 1. Department of Infectious Diseases and Infection Control, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. Electronic address: bertolloleandro@gmail.com. 2. Department of Infectious Diseases and Infection Control, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Abstract
BACKGROUND: Antimicrobial stewardship programs (ASPs) have been proposed as a solution for the global burden of antibiotic resistance, despite the lack of evidence on the subject. OBJECTIVE: To analyze the role of ASPs in reducing bacterial resistance to antibiotics in hospital settings. DATA SOURCES: A review in PubMed, Scopus, LILACS, and SciELO databases was performed. The period analyzed was January 1, 2012-January 4, 2017. ELIGIBILITY CRITERIA: Studies that related ASPs to bacterial resistance. DATA EXTRACTION: All studies that did not focus on ASPs were removed. Antifungal and antiviral programs were excluded. RESULTS: Only 8 studies had quasi-experimental designs, and none were controlled trials. ASP strategies and microorganism-antibiotic pairs evaluated varied widely. Seven studies were classified as presenting clearly positive results, 3 had limited positive results, 7 had doubtful results, 4 had negative results, and 5 had noninterpretable results. The implementation of new infection control practices occurred in 7 studies. LIMITATIONS: There are yet few studies on this matter, and most of them have inadequate study designs. Great heterogeneity between study features was detrimental to drawing evidence-based conclusions. CONCLUSIONS: There is no solid evidence that ASPs are effective in reducing antibiotic resistance in hospital settings. We uphold the need for more studies with appropriate study designs, standardized ASP interventions targeting common microorganism-antibiotic pairs, and avoiding simultaneous implementation of infection control practices.
BACKGROUND: Antimicrobial stewardship programs (ASPs) have been proposed as a solution for the global burden of antibiotic resistance, despite the lack of evidence on the subject. OBJECTIVE: To analyze the role of ASPs in reducing bacterial resistance to antibiotics in hospital settings. DATA SOURCES: A review in PubMed, Scopus, LILACS, and SciELO databases was performed. The period analyzed was January 1, 2012-January 4, 2017. ELIGIBILITY CRITERIA: Studies that related ASPs to bacterial resistance. DATA EXTRACTION: All studies that did not focus on ASPs were removed. Antifungal and antiviral programs were excluded. RESULTS: Only 8 studies had quasi-experimental designs, and none were controlled trials. ASP strategies and microorganism-antibiotic pairs evaluated varied widely. Seven studies were classified as presenting clearly positive results, 3 had limited positive results, 7 had doubtful results, 4 had negative results, and 5 had noninterpretable results. The implementation of new infection control practices occurred in 7 studies. LIMITATIONS: There are yet few studies on this matter, and most of them have inadequate study designs. Great heterogeneity between study features was detrimental to drawing evidence-based conclusions. CONCLUSIONS: There is no solid evidence that ASPs are effective in reducing antibiotic resistance in hospital settings. We uphold the need for more studies with appropriate study designs, standardized ASP interventions targeting common microorganism-antibiotic pairs, and avoiding simultaneous implementation of infection control practices.
Authors: Haley J Appaneal; Aisling R Caffrey; Maria-Stephanie A Hughes; Vrishali V Lopes; Robin L P Jump; Kerry L LaPlante; David M Dosa Journal: J Am Med Dir Assoc Date: 2019-08-26 Impact factor: 4.669
Authors: José Pablo Díaz-Madriz; Eugenia Cordero-García; José Miguel Chaverri-Fernández; Esteban Zavaleta-Monestel; Josué Murillo-Cubero; Hellen Piedra-Navarro; Marian Hernández-Guillén; Tiffany Jiménez-Méndez Journal: Rev Panam Salud Publica Date: 2020-09-23
Authors: Wallis Rudnick; Michelle Science; Daniel J G Thirion; Kahina Abdesselam; Kelly B Choi; Linda Pelude; Kanchana Amaratunga; Jeannette L Comeau; Bruce Dalton; Johan Delport; Rita Dhami; Joanne Embree; Yannick Émond; Gerald Evans; Charles Frenette; Susan Fryters; Greg German; Jennifer M Grant; Jennifer Happe; Kevin Katz; Pamela Kibsey; Justin Kosar; Joanne M Langley; Bonita E Lee; Marie-Astrid Lefebvre; Jerome A Leis; Allison McGeer; Heather L Neville; Andrew Simor; Kathryn Slayter; Kathryn N Suh; Alena Tse-Chang; Karl Weiss; John Conly Journal: Antimicrob Resist Infect Control Date: 2020-02-13 Impact factor: 4.887