UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.
School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, Australia; Metro North Hospital and Health Service, Herston, QLD, Australia.
Am J Infect Control. 2024 Jan;52(1):107-122. doi: 10.1016/j.ajic.2023.08.013. Epub 2023 Aug 19.
Antimicrobial stewardship (AMS) guidelines advocate for the use of antibiograms (cumulative antimicrobial susceptibility test data) as a tool to guide empirical antibiotic prescribing and inform local treatment guidelines. The objective of this review is to evaluate the effectiveness of antibiograms as an intervention to optimize antimicrobial prescribing and patient outcomes.
Embase, PubMed, CINAHL, and International Pharmacy Abstracts (IPA) databases were searched from inception until September 2022, to identify studies of antibiogram-related interventions in all health care settings. The National Institutes of Health Quality Assessment Tools were used to assess the methodological quality of the included studies.
Of the 37 included studies, the majority of studies were conducted in the United States (n = 25) and in hospital settings (n = 27). All interventions were multifaceted and in 26 (70%) studies, facility-specific antibiograms could be considered as an integral component of the interventions. A positive impact on antibiotic consumption trends (17 studies), appropriateness of prescribing (16 studies), and cost of treatment (6 studies) was found, with minimal evidence for improvement in mortality, hospitalization, and resistance profiles. Due to the heterogeneity in study designs and outcomes, a meta-analysis was not performed.
AMS interventions including antibiograms may improve antibiotic use, appropriateness, and costs. Multifaceted interventions were often used, which precludes drawing conclusions about the effectiveness of antibiograms alone as an AMS tool.
抗菌药物管理（AMS）指南提倡使用药敏谱（累积抗菌药物敏感性测试数据）作为指导经验性抗生素处方和制定当地治疗指南的工具。本综述的目的是评估药敏谱作为干预措施优化抗菌药物处方和患者结局的有效性。
从建库到 2022 年 9 月，检索 Embase、PubMed、CINAHL 和国际药学文摘（IPA）数据库，以确定所有医疗保健环境中与药敏谱相关干预措施的研究。使用美国国立卫生研究院质量评估工具评估纳入研究的方法学质量。
在 37 项纳入的研究中，大多数研究在美国（n=25）和医院环境中进行（n=27）。所有干预措施都是多方面的，在 26 项（70%）研究中，可以将特定机构的药敏谱视为干预措施的一个组成部分。发现对抗生素消费趋势（17 项研究）、处方适宜性（16 项研究）和治疗成本（6 项研究）有积极影响，死亡率、住院率和耐药谱改善的证据很少。由于研究设计和结局存在异质性，因此未进行荟萃分析。
包括药敏谱在内的 AMS 干预措施可能会改善抗生素的使用、适宜性和成本。多方面的干预措施经常被使用，这使得无法单独得出关于药敏谱作为 AMS 工具的有效性的结论。
