Clinical impact of antibiograms as an intervention to optimize antimicrobial prescribing and patient outcomes-A systematic review.

Antimicrobial resistance Antimicrobial stewardship Cumulative antimicrobial susceptibility test

Journal

American journal of infection control
ISSN: 1527-3296
Titre abrégé: Am J Infect Control
Pays: United States
ID NLM: 8004854

Informations de publication

Date de publication:
19 Aug 2023
Historique:
received: 27 05 2023
revised: 14 08 2023
accepted: 16 08 2023
pubmed: 22 8 2023
medline: 22 8 2023
entrez: 21 8 2023
Statut: aheadofprint

Résumé

Antimicrobial stewardship (AMS) guidelines advocate for the use of antibiograms (cumulative antimicrobial susceptibility test data) as a tool to guide empirical antibiotic prescribing and inform local treatment guidelines. The objective of this review is to evaluate the effectiveness of antibiograms as an intervention to optimize antimicrobial prescribing and patient outcomes. Embase, PubMed, CINAHL, and International Pharmacy Abstracts (IPA) databases were searched from inception until September 2022, to identify studies of antibiogram-related interventions in all health care settings. The National Institutes of Health Quality Assessment Tools were used to assess the methodological quality of the included studies. Of the 37 included studies, the majority of studies were conducted in the United States (n = 25) and in hospital settings (n = 27). All interventions were multifaceted and in 26 (70%) studies, facility-specific antibiograms could be considered as an integral component of the interventions. A positive impact on antibiotic consumption trends (17 studies), appropriateness of prescribing (16 studies), and cost of treatment (6 studies) was found, with minimal evidence for improvement in mortality, hospitalization, and resistance profiles. Due to the heterogeneity in study designs and outcomes, a meta-analysis was not performed. AMS interventions including antibiograms may improve antibiotic use, appropriateness, and costs. Multifaceted interventions were often used, which precludes drawing conclusions about the effectiveness of antibiograms alone as an AMS tool.

Sections du résumé

BACKGROUND BACKGROUND
Antimicrobial stewardship (AMS) guidelines advocate for the use of antibiograms (cumulative antimicrobial susceptibility test data) as a tool to guide empirical antibiotic prescribing and inform local treatment guidelines. The objective of this review is to evaluate the effectiveness of antibiograms as an intervention to optimize antimicrobial prescribing and patient outcomes.
METHODS METHODS
Embase, PubMed, CINAHL, and International Pharmacy Abstracts (IPA) databases were searched from inception until September 2022, to identify studies of antibiogram-related interventions in all health care settings. The National Institutes of Health Quality Assessment Tools were used to assess the methodological quality of the included studies.
RESULTS RESULTS
Of the 37 included studies, the majority of studies were conducted in the United States (n = 25) and in hospital settings (n = 27). All interventions were multifaceted and in 26 (70%) studies, facility-specific antibiograms could be considered as an integral component of the interventions. A positive impact on antibiotic consumption trends (17 studies), appropriateness of prescribing (16 studies), and cost of treatment (6 studies) was found, with minimal evidence for improvement in mortality, hospitalization, and resistance profiles. Due to the heterogeneity in study designs and outcomes, a meta-analysis was not performed.
CONCLUSIONS CONCLUSIONS
AMS interventions including antibiograms may improve antibiotic use, appropriateness, and costs. Multifaceted interventions were often used, which precludes drawing conclusions about the effectiveness of antibiograms alone as an AMS tool.

Identifiants

DOI: 10.1016/j.ajic.2023.08.013 PMID: 37604208
pubmed: 37604208
pii: S0196-6553(23)00574-6
doi: 10.1016/j.ajic.2023.08.013
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

Auteurs

Dipti Khatri (D)

UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia. Electronic address: d.khatri@uq.edu.au.

Christopher Freeman (C)

School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, Australia; Metro North Hospital and Health Service, Herston, QLD, Australia. Electronic address: c.freeman4@uq.edu.au.

Nazanin Falconer (N)

UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia; School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia; Princess Alexandra Hospital, Metro South Health, Woolloongabba, QLD, Australia.

Soraia de Camargo Catapan (S)

UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia; UQ Centre for Online Health (COH), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.

Leonard C Gray (LC)

UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.

David L Paterson (DL)

Faculty of Medicine, The University of Queensland, Herston, QLD, Australia; Metro North Hospital and Health Service, Herston, QLD, Australia; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.

Classifications MeSH