Belan Martin, Thilly Nathalie, Pulcini Céline
Université de Lorraine, CHRU-Nancy, Département de maladies infectieuses, Nancy, France.
Université de Lorraine, APEMAC, Nancy, France.
J Antimicrob Chemother. 2020 Jun 1;75(6):1390-1397. doi: 10.1093/jac/dkaa013.
Antimicrobial overuse/misuse is common in nursing homes and although the effectiveness of antimicrobial stewardship (AMS) programmes has been well explored and demonstrated in hospitals, data are scarce for the nursing-home setting. Our objectives for this systematic review were to make an inventory of: (i) all interventions that could be considered as part of AMS programmes in nursing homes; and (ii) all stewardship tools and guidance that are freely available.
We performed a systematic review using the MEDLINE database from inception to June 2018, including all interventional studies, reviews, opinion pieces and guidelines/guidance exploring AMS programmes in nursing homes. For the inventory of freely available tools and guidance to help implement an AMS programme, we also performed screening of professional societies and official agencies' websites and a questionnaire survey among a panel of international experts.
A total of 36 articles were included in our systematic review. Most interventions took place in North America and have explored education or persuasive interventions within multifaceted interventions, showing that they can improve guideline adherence and decrease antibiotic use and unnecessary microbiological testing. Most reviews also highlighted the importance of accountability, monitoring and feedback. A large number of tools (156) available for free on the internet were identified, mostly about education, patient assessment and outcome measurement.
Although high-quality interventional studies are lacking, multifaceted interventions including education, monitoring and feedback seem the most promising strategy. Many tools are available on the internet and can be used to help implement AMS programmes in nursing homes.
抗菌药物的过度使用/误用在疗养院中很常见。尽管抗菌药物管理（AMS）计划的有效性已在医院中得到充分探索和证明，但在疗养院环境中的数据却很少。我们进行这项系统评价的目的是梳理出：（i）所有可被视为疗养院AMS计划一部分的干预措施；（ii）所有免费提供的管理工具和指南。
我们使用MEDLINE数据库进行了一项系统评价，涵盖从数据库建立到2018年6月的所有研究，包括所有探讨疗养院AMS计划的干预性研究、综述、观点文章和指南/指导意见。为了梳理出有助于实施AMS计划的免费工具和指南清单，我们还对专业协会和官方机构的网站进行了筛选，并对一组国际专家进行了问卷调查。
我们的系统评价共纳入36篇文章。大多数干预措施发生在北美，并且在多方面干预措施中探索了教育或说服性干预措施，结果表明这些措施可以提高指南依从性，并减少抗生素使用和不必要的微生物检测。大多数综述还强调了问责制、监测和反馈的重要性。我们在互联网上识别出大量免费提供的工具（156种），其中大部分是关于教育、患者评估和结果测量的。
尽管缺乏高质量的干预性研究，但包括教育、监测和反馈在内的多方面干预措施似乎是最有前景的策略。互联网上有许多工具可供使用，可帮助在疗养院中实施AMS计划。
