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Antimicrobial Stewardship Programs in Inpatient Hospital Settings: A Systematic Review

Published online by Cambridge University Press:  10 May 2016

Brittin Wagner ,
Gregory A. Filice ,
Dimitri Drekonja ,
Nancy Greer ,
Roderick MacDonald ,
Indulis Rutks ,
Mary Butler  and
Timothy J. Wilt
Brittin Wagner
Affiliation:
Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Department of Medicine, University of Minnesota, Minneapolis, Minnesota
Gregory A. Filice
Affiliation:
Department of Medicine, University of Minnesota, Minneapolis, Minnesota Infectious Disease Service, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
Dimitri Drekonja
Affiliation:
Department of Medicine, University of Minnesota, Minneapolis, Minnesota Infectious Disease Service, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
Nancy Greer
Affiliation:
Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
Roderick MacDonald
Affiliation:
Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
Indulis Rutks
Affiliation:
Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
Mary Butler
Affiliation:
University of Minnesota School of Public Health, Minneapolis, Minnesota
Timothy J. Wilt*
Affiliation:
Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Department of Medicine, University of Minnesota, Minneapolis, Minnesota
*
MPH, Minneapolis Veterans Affairs Health Care System, One Veterans Drive, Mail Code 111-O, Minneapolis, MN 55417 (tim.wilt@va.gov).
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Abstract

Objective

Evaluate the evidence for effects of inpatient antimicrobial stewardship programs (ASPs) on patient, prescribing, and microbial outcomes.

Design

Systematic review.

Methods

Search of MEDLINE (2000 through November 2013), Cochrane Library, and reference lists of relevant studies. We included English language studies with patient populations relevant to the United States (ie, infectious conditions and prescriptions required for antimicrobials) that evaluated ASP interventions and reported outcomes of interest. Study characteristics and outcomes data were extracted and reviewed by investigators and trained research personnel.

Results

Few intervention types (eg, audit and feedback, guideline implementation, and decision support) substantially impacted patient outcomes, including mortality, length of stay, readmission, or incidence of Clostridium difficile infection. However, most interventions were not powered adequately to demonstrate impacts on patient outcomes. Most interventions were associated with improved prescribing patterns as measured by decreased antimicrobial use or increased appropriate use. Where reported, ASPs were generally associated with improvements in microbial outcomes, including institutional resistance patterns or resistance in the study population. Few data were provided on harms, sustainability, or key intervention components. Studies were typically of short duration, low in methodological quality, and varied in study design, populations enrolled, hospital setting, ASP intent, intervention composition and implementation, comparison group, and outcomes assessed.

Conclusions

Numerous studies suggest that ASPs can improve prescribing and microbial outcomes. Strength of evidence was low, and most studies were not designed adequately to detect improvements in mortality or other patient outcomes, but obvious adverse effects on patient outcomes were not reported.

Type
Review Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 10 , October 2014 , pp. 1209 - 1228
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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