Sefah Israel Abebrese, Chetty Sarentha, Yamoah Peter, Bangalee Varsha
Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana.
Syst Rev. 2024 Dec 19;13(1):306. doi: 10.1186/s13643-024-02731-w.
Surgical antimicrobial prophylaxis (SAP) is an effective infection prevention strategy used to reduce postoperative surgical site infection. Inappropriate use of SAP is a concern in low-middle-income countries (LMICs) due to increased mortality risks, adverse reactions, re-admission rates and length of hospital stay. Antimicrobial Stewardship Programs (ASP) have been shown to be effective in improving the appropriate use of antibiotics including the use of SAP. The aim of this review was to evaluate the impact of ASP on the appropriate use of SAP and its implication on patient outcomes in LMICs.
The protocol for this review was registered in PROSPERO. Studies published between 1st January 2010 and 31st December 2023 were searched electronically from Medline, Central Cochrane Library, web of science, CINAHL and APA PsychInfo databases. Studies were included if they assessed the impact of ASP interventions on SAP use in low- and middle-income countries (LMICs). Studies were evaluated using the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool for non-randomized and before and after studies as well as the Cochrane Risk of Bias 2 (ROB 2) tool for randomized studies. Findings were summarized in tables.
Twenty studies comprising of seventeen before-after studies, two interrupted time series, and one randomized controlled trial were included. Penicillins and cephalosporins were the most commonly used antibiotics for SAP. Most (50%) of the studies were conducted in Asia followed by Africa (45%). While 80% of the studies showed the impact of ASP on compliance to SAP guidelines, only 45% showed an impact on antibiotic utilization. Again, 50% and 60% showed an impact on reducing antibiotic costs and patient length of stay at hospitals respectively. Patient outcomes including rates of surgical site infections and mortality showed no significant change. The studies showed a high risk of bias mainly due to the choice of study designs.
ASP interventions in LMICs are effective in improving SAP guideline adherence, antibiotic utilization and their cost. Deliberate effort must be made to improve on the quality of future interventional studies in these settings to guide practice and encourage other LMICs to conduct such studies to assess the influence of different geographical contexts on SAP use.
外科抗菌药物预防性应用（SAP）是一种有效的感染预防策略，用于降低术后手术部位感染。在低收入和中等收入国家（LMICs），由于死亡风险增加、不良反应、再入院率和住院时间延长，SAP的不当使用令人担忧。抗菌药物管理计划（ASP）已被证明在改善抗生素的合理使用（包括SAP的使用）方面是有效的。本综述的目的是评估ASP对LMICs中SAP合理使用的影响及其对患者结局的影响。
本综述的方案已在PROSPERO注册。从Medline、Cochrane中央图书馆、科学网、CINAHL和APA PsychInfo数据库中检索了2010年1月1日至2023年12月31日期间发表的研究。如果研究评估了ASP干预对低收入和中等收入国家（LMICs）中SAP使用的影响，则纳入研究。使用非随机干预研究中的偏倚风险（ROBINS-I）工具对非随机研究和前后研究进行评估，并使用Cochrane偏倚风险2（ROB 2）工具对随机研究进行评估。研究结果汇总在表格中。
纳入了20项研究，其中包括17项前后研究、2项中断时间序列研究和1项随机对照试验。青霉素和头孢菌素是SAP最常用的抗生素。大多数（50%）研究在亚洲进行，其次是非洲（45%）。虽然80%的研究显示了ASP对遵守SAP指南的影响，但只有45%的研究显示了对抗生素使用的影响。此外，分别有50%和60%的研究显示对降低抗生素成本和患者住院时间有影响。包括手术部位感染率和死亡率在内的患者结局没有显著变化。这些研究显示出较高的偏倚风险，主要是由于研究设计的选择。
LMICs中的ASP干预在改善SAP指南依从性、抗生素使用及其成本方面是有效的。必须做出刻意努力，提高这些环境中未来干预性研究的质量，以指导实践，并鼓励其他LMICs开展此类研究，以评估不同地理环境对SAP使用的影响。
