MedStar Washington Hospital Center, DC, USA.
New York University Rory Meyers College of Nursing, New York City, USA.
J Appl Gerontol. 2022 Mar;41(3):892-901. doi: 10.1177/07334648211018299. Epub 2021 Jun 2.
Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988-2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran's = 166,837.8, < .001, = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.
抗生素管理计划（ASP）干预措施对优化疗养院（NH）居民感染抗生素使用的效果仍不清楚。本系统评价和荟萃分析的目的是评估 NH 中的 ASP 及其对抗生素使用、多药耐药菌、抗生素处方实践和居民死亡率的影响。根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，我们使用五个数据库（1988-2020 年）进行了系统评价和荟萃分析。纳入了 19 篇文章，其中 10 篇符合定量综合的标准。八项研究表明，ASP 干预后抗生素使用不当减少，总体减少 13.8%（95%置信区间[CI]：[4.7, 23.0]；Cochran's = 166,837.8，<.001， = 99.9%）。在研究尿路感染（UTI）抗生素使用的研究中，抗生素使用不当的减少幅度最大。针对 UTI 的教育和抗生素管理算法是最有效的干预措施。NH 中 ASP 的证据较弱，建议适用于 UTI。
