Incidence of Drug-Resistant Infection Lowered With Antibiotic Stewardship Programs
Antibiotic stewardship programs are associated with a significantly lower incidence of infections and colonization with antibiotic-resistant bacteria and Clostridium difficile infections among hospital inpatients, according to a recent meta-analysis.
For their analysis, the researchers assessed 32 studies containing 9,056,241 patient-days and 159 estimates of incidence ratios (IRs). All studies included in the analysis had been published between January 1, 1960, and May 31, 2016. Patient data was independently extracted by 2 authors, and was obtained via searches of PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Web of Science databases.
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The primary outcomes were IRs of target infections and colonization per 1000 patient-days prior to and after implementation of antibiotic stewardship. Random-effects models were used to conduct meta-analyses. The I2 method was used to calculate heterogeneity.
Ultimately, results indicated that antibiotic stewardship programs were associated with decreased incidence of infections and colonization with multidrug-resistant Gram-negative bacteria (51% reduction), extended-spectrum β-lactamase-producing Gram-negative bacteria (48% reduction), meticillin-resistant Staphylococcus aureus (37% reduction), and C. difficile infections (32% reduction). The researchers found that antibiotic stewardship programs had been more effective when implemented with infection control measures such as hand-hygiene interventions vs when implemented alone.
Antibiotic stewardship had no effect on the IRs of vancomycin-resistant enterococci and quinolone-resistant and aminoglycoside-resistant Gram-negative bacteria. Significant heterogeneity between studies was evident. According to the researchers, this was partly due to the type of interventions and co-resistance patterns of the target bacteria.
“Antibiotic stewardship programs significantly reduce the incidence of infections and colonization with antibiotic-resistant bacteria and C. difficile infections in hospital inpatients,” the researchers concluded. “These results provide stakeholders and policy makers with evidence for implementation of antibiotic stewardship interventions to reduce the burden of infections from antibiotic-resistant bacteria.”
—Christina Vogt
Reference:
Baur D, Gladstone BP, Burkert F, et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. The Lancet Infect Dis. 2017;17(9):990-1001. http://dx.doi.org/10.1016/S1473-3099(17)30325-0.