Impact of antibiotic stewardship programmes in Asia: a systematic review and meta-analysis

Abstract

Background: 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.

Objectives: To determine the impact of ASPs conducted in Asia on the consumption of antibiotics and on patients' clinical outcomes.

Methods: 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.

Results: 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.

Conclusions: 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.

Figure 1.

Flow diagram of study selection.

Figure 2.

Forest plots of the impact of stewardship programmes on mortality rates. (a) Studies reporting a stewardship programme with drug control or monitoring, formulary restriction or intravenous-to-oral conversion. (b) Studies reporting a stewardship programme without drug control or monitoring, formulary restriction or intravenous-to-oral conversion.

Figure 3.

Forest plots of the impact of stewardship programmes on hospital-acquired infection rates. (a) Studies reporting a stewardship programme with an infection control or hand hygiene programme. (b) Studies reporting a stewardship programme without an infection control or hand hygiene programme.