Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

Abstract

Antimicrobial stewardship interventions are targeted efforts by healthcare organizations to optimize antimicrobial use in clinical practice. The study aimed to explore effective interventions in improving antimicrobial use in hospitals. Literature was systemically searched for interventional studies through PubMed, CINAHL, and Scopus databases that were published in the period between January 2010 to April 2022. A random-effects model was used to pool and evaluate data from eligible studies that reported antimicrobial stewardship (AMS) interventions in outpatient and inpatient settings. Pooled estimates presented as proportions and standardized mean differences. Forty-eight articles were included in this review: 32 in inpatient and 16 in outpatient settings. Seventeen interventions have been identified, and eight outcomes have been targeted. AMS interventions improved clinical, microbiological, and cost outcomes in most studies. When comparing non-intervention with intervention groups using meta-analysis, there was an insignificant reduction in length of stay (MD: -0.99; 95% CI: -2.38, 0.39) and a significant reduction in antibiotics' days of therapy (MD: -2.73; 95% CI: -3.92, -1.54). There were noticeable reductions in readmissions, mortality rates, and antibiotic prescriptions post antimicrobial stewardship multi-disciplinary team (AMS-MDT) interventions. Studies that involved a pharmacist as part of the AMS-MDT showed more significant improvement in measured outcomes than the studies that did not involve a pharmacist.

Keywords: antimicrobial stewardship; antimicrobial use; clinical practice; interventions; multidisciplinary team.

Figure 1

PRISMA flow diagram of the process of study selection.

Figure 2

(a) RCTs risk of bias assessment using ROB-2 tool; (b) ROBIN-1 risk of bias assessment for non-randomized trials.

Figure 2

(a) RCTs risk of bias assessment using ROB-2 tool; (b) ROBIN-1 risk of bias assessment for non-randomized trials.

Figure 3

Pooled data from inpatient studies representing the impact of antimicrobial stewardship program intervention on length of hospital stay when comparing non-intervention with intervention groups.

Figure 4

Pooled data from inpatient studies representing the impact of antimicrobial stewardship program intervention on days of antibiotic therapy when comparing non-intervention with intervention groups.

Figure 5

Prevalence of 30-day readmission within the inpatient setting in non-intervention and intervention groups.

Figure 6

Prevalence of mortality within the inpatient setting in non-intervention and intervention groups.

Figure 7

(a) Prevalence of patients prescribed antibiotics in accordance with hospital guidelines within the inpatient setting in the non-intervention and intervention groups; (b) Prevalence of patients prescribed antibiotics in accordance with hospital guidelines within the outpatient setting in the non-intervention and intervention groups.

Figure 8

Prevalence of patients prescribed antibiotics in accordance with hospital guidelines within the outpatient setting in the non-intervention and intervention groups.