WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
J Antimicrob Chemother. 2018 Apr 1;73(4):844-851. doi: 10.1093/jac/dkx492.
The use of antibiotic stewardship programmes (ASPs) is increasing in Asia, but their effectiveness in reducing antibiotic consumption and their impact on clinical outcomes is not known.
To determine the impact of ASPs conducted in Asia on the consumption of antibiotics and on patients' clinical outcomes.
We systematically searched the Embase and Medline (PubMed) databases for studies that compared antibiotic consumption or clinical outcomes of patients in an Asian hospital or clinic with an ASP (intervention) with those in a similar setting without an ASP (control). Meta-analyses of all-cause mortality and hospital-acquired infection (HAI) were performed using random-effects models.
The search identified 77 studies of which 22 and 19 reported antibiotic usage and cost, respectively. Among these, 20 (91%) studies reported reduced antibiotic usage and 19 (100%) reported cost savings in the intervention group. Duration of antibiotic therapy was reduced in six of seven studies in association with an ASP. Rates of all-cause mortality and HAI were not significantly different between the intervention and control groups. However, mortality rates were significantly improved by ASPs using drug monitoring, while HAI rates were also improved by ASPs that included infection control or hand hygiene programmes.
In Asia, ASPs reduce antibiotic consumption in hospital and clinic settings and do not worsen clinical outcomes. The findings strongly support the broad implementation of antimicrobial stewardship interventions in hospital and clinic settings in Asia.
抗生素管理项目（ASPs）在亚洲的应用正在增加，但它们在减少抗生素使用量和对临床结果的影响方面的效果尚不清楚。
确定亚洲开展的 ASP 对抗生素使用量以及患者临床结果的影响。
我们系统地检索了 Embase 和 Medline（PubMed）数据库，以查找将亚洲医院或诊所中接受 ASP（干预）的患者与未接受 ASP（对照）的类似环境中的患者的抗生素使用量或临床结果进行比较的研究。使用随机效应模型对全因死亡率和医院获得性感染（HAI）进行荟萃分析。
搜索共确定了 77 项研究，其中 22 项和 19 项分别报告了抗生素使用量和费用。在这些研究中，有 20 项（91%）报告了抗生素使用量减少，19 项（100%）报告了干预组的成本节约。与 ASP 相关的有 6/7 项研究报告了抗生素治疗持续时间的缩短。干预组和对照组之间的全因死亡率和 HAI 发生率没有显著差异。然而，使用药物监测的 ASP 可显著改善死亡率，而包括感染控制或手卫生计划的 ASP 也可改善 HAI 率。
在亚洲，ASPs 可减少医院和诊所环境中的抗生素使用量，且不会恶化临床结果。这些发现强烈支持在亚洲的医院和诊所环境中广泛实施抗菌药物管理干预措施。
