Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis: Lancet Infectious Diseases

E. C. Schuts, M.E.J.L. Hulscher, J.W. Mouton, C. M. Verduin, Jwtc Stuart, Hwpm Overdiek, P.W.G. van der Linden, S. Natsch, Cmpm Hertogh, T.F.W. Wolfs, J. A. Schouten, B.J. Kullberg, Jan M Prins

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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
Original languageEnglish
Pages (from-to)847-856
Number of pages10
JournalLancet Infectious Diseases
Volume16
DOIs
Publication statusPublished - 2016

Cite this

Schuts, E. C., Hulscher, M. E. J. L., Mouton, J. W., Verduin, C. M., Stuart, J., Overdiek, H., ... Prins, J. M. (2016). Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis: Lancet Infectious Diseases. Lancet Infectious Diseases, 16, 847-856. https://doi.org/10.1016/s1473-3099(16)00065-7
Schuts, E. C. ; Hulscher, M.E.J.L. ; Mouton, J.W. ; Verduin, C. M. ; Stuart, Jwtc ; Overdiek, Hwpm ; van der Linden, P.W.G. ; Natsch, S. ; Hertogh, Cmpm ; Wolfs, T.F.W. ; Schouten, J. A. ; Kullberg, B.J. ; Prins, Jan M. / Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis : Lancet Infectious Diseases. In: Lancet Infectious Diseases. 2016 ; Vol. 16. pp. 847-856.
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abstract = "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",
author = "Schuts, {E. C.} and M.E.J.L. Hulscher and J.W. Mouton and Verduin, {C. M.} and Jwtc Stuart and Hwpm Overdiek and {van der Linden}, P.W.G. and S. Natsch and Cmpm Hertogh and T.F.W. Wolfs and Schouten, {J. A.} and B.J. Kullberg and Prins, {Jan M}",
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Schuts, EC, Hulscher, MEJL, Mouton, JW, Verduin, CM, Stuart, J, Overdiek, H, van der Linden, PWG, Natsch, S, Hertogh, C, Wolfs, TFW, Schouten, JA, Kullberg, BJ & Prins, JM 2016, 'Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis: Lancet Infectious Diseases' Lancet Infectious Diseases, vol. 16, pp. 847-856. https://doi.org/10.1016/s1473-3099(16)00065-7

Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis : Lancet Infectious Diseases. / Schuts, E. C.; Hulscher, M.E.J.L.; Mouton, J.W.; Verduin, C. M.; Stuart, Jwtc; Overdiek, Hwpm; van der Linden, P.W.G.; Natsch, S.; Hertogh, Cmpm; Wolfs, T.F.W.; Schouten, J. A.; Kullberg, B.J.; Prins, Jan M.

In: Lancet Infectious Diseases, Vol. 16, 2016, p. 847-856.

Research output: Contribution to journalArticleAcademicpeer-review

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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

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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

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JO - Lancet Infectious Diseases

JF - Lancet Infectious Diseases

SN - 1473-3099

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