Division of Infectious Disease, Department of Internal Medicine I, DZIF Partner site, Tübingen University Hospital, Tübingen, Germany.
Division of Infectious Disease, Department of Internal Medicine I, DZIF Partner site, Tübingen University Hospital, Tübingen, Germany.
Lancet Infect Dis. 2017 Sep;17(9):990-1001. doi: 10.1016/S1473-3099(17)30325-0. Epub 2017 Jun 16.
Antibiotic stewardship programmes have been shown to reduce antibiotic use and hospital costs. We aimed to evaluate evidence of the effect of antibiotic stewardship on the incidence of infections and colonisation with antibiotic-resistant bacteria.
For this systematic review and meta-analysis, we searched PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Web of Science for studies published from Jan 1, 1960, to May 31, 2016, that analysed the effect of antibiotic stewardship programmes on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infections in hospital inpatients. Two authors independently assessed the eligibility of trials and extracted data. Studies involving long-term care facilities were excluded. The main outcomes were incidence ratios (IRs) of target infections and colonisation per 1000 patient-days before and after implementation of antibiotic stewardship. Meta-analyses were done with random-effect models and heterogeneity was calculated with the I method.
We included 32 studies in the meta-analysis, comprising 9 056 241 patient-days and 159 estimates of IRs. Antibiotic stewardship programmes reduced the incidence of infections and colonisation with multidrug-resistant Gram-negative bacteria (51% reduction; IR 0·49, 95% CI 0·35-0·68; p<0·0001), extended-spectrum β-lactamase-producing Gram-negative bacteria (48%; 0·52, 0·27-0·98; p=0·0428), and meticillin-resistant Staphylococcus aureus (37%; 0·63, 0·45-0·88; p=0·0065), as well as the incidence of C difficile infections (32%; 0·68, 0·53-0·88; p=0·0029). Antibiotic stewardship programmes were more effective when implemented with infection control measures (IR 0·69, 0·54-0·88; p=0·0030), especially hand-hygiene interventions (0·34, 0·21-0·54; p<0·0001), than when implemented alone. Antibiotic stewardship did not affect the IRs of vancomycin-resistant enterococci and quinolone-resistant and aminoglycoside-resistant Gram-negative bacteria. Significant heterogeneity between studies was detected, which was partly explained by the type of interventions and co-resistance patterns of the target bacteria.
Antibiotic stewardship programmes significantly reduce the incidence of infections and colonisation with antibiotic-resistant bacteria and C difficile infections in hospital inpatients. 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.
German Center for Infection Research.
抗生素管理计划已被证明可减少抗生素的使用和医院的成本。我们旨在评估抗生素管理对感染和抗生素耐药菌定植发生率的影响的证据。
本系统综述和荟萃分析检索了 1960 年 1 月 1 日至 2016 年 5 月 31 日发表的来自 PubMed、Cochrane 系统评价数据库、Cochrane 对照试验中心注册库和 Web of Science 的研究，分析了抗生素管理计划对住院患者感染和抗生素耐药菌定植以及艰难梭菌感染发生率的影响。两名作者独立评估了试验的纳入标准并提取了数据。不包括长期护理机构的研究。主要结局是在实施抗生素管理前后每 1000 患者日的目标感染和定植的发病率比（IR）。使用随机效应模型进行荟萃分析，并使用 I 方法计算异质性。
我们将 32 项研究纳入荟萃分析，包括 9056241 个患者日和 159 个 IR 估计值。抗生素管理计划降低了感染和耐多药革兰阴性菌定植的发生率（51%的降幅；IR 0.49，95%CI 0.35-0.68；p<0.0001），产超广谱β-内酰胺酶的革兰阴性菌（48%；0.52，0.27-0.98；p=0.0428）和耐甲氧西林金黄色葡萄球菌（37%；0.63，0.45-0.88；p=0.0065）的发生率，以及艰难梭菌感染的发生率（32%；0.68，0.53-0.88；p=0.0029）。当与感染控制措施一起实施时，抗生素管理计划更有效（IR 0.69，0.54-0.88；p=0.0030），尤其是手部卫生干预措施（0.34，0.21-0.54；p<0.0001），而单独实施时效果不佳。抗生素管理计划对万古霉素耐药肠球菌和喹诺酮耐药及氨基糖苷类耐药革兰阴性菌的 IR 没有影响。研究之间存在显著的异质性，这在一定程度上可以解释为干预措施的类型和目标细菌的共同耐药模式。
抗生素管理计划可显著降低住院患者感染和抗生素耐药菌及艰难梭菌感染的发生率。这些结果为利益相关者和决策者提供了实施抗生素管理干预措施的证据，以减少抗生素耐药菌感染的负担。
德国感染研究中心。
