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Association Between Antimicrobial Stewardship Programs and Antibiotic Use Globally: A Systematic Review and Meta-Analysis.

Zay Ya, K; Win, PTN; Bielicki, J; Lambiris, M; Fink, G (2023) Association Between Antimicrobial Stewardship Programs and Antibiotic Use Globally: A Systematic Review and Meta-Analysis. JAMA Netw Open, 6 (2). e2253806. ISSN 2574-3805 https://doi.org/10.1001/jamanetworkopen.2022.53806
SGUL Authors: Bielicki, Julia Anna

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Abstract

IMPORTANCE: Antimicrobial resistance continues to spread rapidly at a global scale. Little evidence exists on the association of antimicrobial stewardship programs (ASPs) with the consumption of antibiotics across health care and income settings. OBJECTIVE: To synthesize current evidence regarding the association between antimicrobial stewardship programs and the consumption of antibiotics globally. DATA SOURCES: PubMed, Web of Science, and Scopus databases were searched from August 1, 2010, to Aug 1, 2020. Additional studies from the bibliography sections of previous systematic reviews were included. STUDY SELECTION: Original studies of the association of ASPs with antimicrobial consumption across health care and income settings. Animal and environmental studies were excluded. DATA EXTRACTION AND SYNTHESIS: Following the Preferred Reporting Items in Systematic Reviews and Meta-Analyses guideline, the pooled association of targeted ASPs with antimicrobial consumption was measured using multilevel random-effects models. The Effective Public Health Practice Project quality assessment tool was used to assess study quality. MAIN OUTCOMES AND MEASURES: The main outcome measures were proportion of patients receiving an antibiotic prescription and defined daily doses per 100 patient-days. RESULTS: Overall, 52 studies (with 1 794 889 participants) measured the association between ASPs and antimicrobial consumption and were included, with 40 studies conducted in high-income countries and 12 in low- and middle-income countries (LMICs). ASPs were associated with a 10% (95% CI, 4%-15%) reduction in antibiotic prescriptions and a 28% reduction in antibiotic consumption (rate ratio, 0.72; 95% CI, 0.56-0.92). ASPs were also associated with a 21% (95% CI, 5%-36%) reduction in antibiotic consumption in pediatric hospitals and a 28% reduction in World Health Organization watch groups antibiotics (rate ratio, 0.72; 95% CI, 0.56-0.92). CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, ASPs appeared to be effective in reducing antibiotic consumption in both hospital and nonhospital settings. Impact assessment of ASPs in resource-limited settings remains scarce; further research is needed on how to best achieve reductions in antibiotic use in LMICs.

Item Type: Article
Additional Information: This is an open access article distributed under the terms of the CC-BY License (https://jamanetwork.com/pages/cc-by-license-permissions). © 2023 Zay Ya K et al. JAMA Network Open.
Keywords: Humans, Child, Anti-Bacterial Agents, Antimicrobial Stewardship, Anti-Infective Agents, Prescriptions, Hospitals, Pediatric
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: JAMA Netw Open
ISSN: 2574-3805
Language: eng
Dates:
DateEvent
1 February 2023Published
9 February 2023Published Online
9 December 2022Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
801076Horizon 2020http://dx.doi.org/10.13039/501100007601
PubMed ID: 36757700
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/115196
Publisher's version: https://doi.org/10.1001/jamanetworkopen.2022.53806

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