TY - JOUR
T1 - Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis
T2 - Lancet Infectious Diseases
AU - Schuts, E. C.
AU - Hulscher, M.E.J.L.
AU - Mouton, J.W.
AU - Verduin, C. M.
AU - Stuart, Jwtc
AU - Overdiek, Hwpm
AU - van der Linden, P.W.G.
AU - Natsch, S.
AU - Hertogh, Cmpm
AU - Wolfs, T.F.W.
AU - Schouten, J. A.
AU - Kullberg, B.J.
AU - Prins, Jan M
N1 - M1 - 7
ISI Document Delivery No.: DP2LH Times Cited: 19 Cited Reference Count: 23 Schuts, Emelie C. Hulscher, Marlies E. J. L. Mouton, Johan W. Verduin, Cees M. Stuart, James W. T. Cohen Overdiek, Hans W. P. M. van der Linden, Paul D. Natsch, Stephanie Hertogh, Cees M. P. M. Wolfs, Tom F. W. Schouten, Jeroen A. Kullberg, Bart Jan Prins, Jan M. 19 6 12 ELSEVIER SCI LTD OXFORD LANCET INFECT DIS
PY - 2016
Y1 - 2016
N2 - Background Antimicrobial stewardship is advocated to improve the quality of antimicrobial use. We did a systematic review and meta-analysis to assess whether antimicrobial stewardship objectives had any effects in hospitals and long-term care facilities on four predefined patients' outcomes: clinical outcomes, adverse events, costs, and bacterial resistance rates. Methods We identified 14 stewardship objectives and did a separate systematic search for articles relating to each one in Embase, Ovid MEDLINE, and PubMed. Studies were included if they reported data on any of the four predefined outcomes in patients in whom the specific antimicrobial stewardship objective was assessed and compared the findings in patients in whom the objective was or was not met. We used a random-effects model to calculate relative risk reductions with relative risks and 95% CIs. Findings We identified 145 unique studies with data on nine stewardship objectives. Overall, the quality of evidence was generally low and heterogeneity between studies was mostly moderate to high. For the objectives empirical therapy according to guidelines, de-escalation of therapy, switch from intravenous to oral treatment, therapeutic drug monitoring, use of a list of restricted antibiotics, and bedside consultation the overall evidence showed significant benefits for one or more of the four outcomes. Guideline-adherent empirical therapy was associated with a relative risk reduction for mortality of 35% (relative risk 0.65, 95% CI 0.54-0.80, p
AB - Background Antimicrobial stewardship is advocated to improve the quality of antimicrobial use. We did a systematic review and meta-analysis to assess whether antimicrobial stewardship objectives had any effects in hospitals and long-term care facilities on four predefined patients' outcomes: clinical outcomes, adverse events, costs, and bacterial resistance rates. Methods We identified 14 stewardship objectives and did a separate systematic search for articles relating to each one in Embase, Ovid MEDLINE, and PubMed. Studies were included if they reported data on any of the four predefined outcomes in patients in whom the specific antimicrobial stewardship objective was assessed and compared the findings in patients in whom the objective was or was not met. We used a random-effects model to calculate relative risk reductions with relative risks and 95% CIs. Findings We identified 145 unique studies with data on nine stewardship objectives. Overall, the quality of evidence was generally low and heterogeneity between studies was mostly moderate to high. For the objectives empirical therapy according to guidelines, de-escalation of therapy, switch from intravenous to oral treatment, therapeutic drug monitoring, use of a list of restricted antibiotics, and bedside consultation the overall evidence showed significant benefits for one or more of the four outcomes. Guideline-adherent empirical therapy was associated with a relative risk reduction for mortality of 35% (relative risk 0.65, 95% CI 0.54-0.80, p
U2 - 10.1016/s1473-3099(16)00065-7
DO - 10.1016/s1473-3099(16)00065-7
M3 - Article
SN - 1473-3099
VL - 16
SP - 847
EP - 856
JO - Lancet Infectious Diseases
JF - Lancet Infectious Diseases
ER -