Antibiotic stewardship programmes reduce certain antibiotic-resistant bacterial infections, colonization
The implementation of antibiotic stewardship programmes, particularly alongside infection control measures, reduced the incidence of infections and colonization caused by several strains of antibiotic-resistant bacteria among hospital inpatients, according to a systematic review and meta-analysis.
“Our meta-analysis shows that antibiotic stewardship programmes have an essential role in combating the development of antibiotic resistance ... and emphasizes the importance of promoting antibiotic stewardship programmes at the hospital level to reduce the spread of antibiotic-resistant bacteria among the inpatient population,” said the researchers.
Following the initiation of antibiotic stewardship programmes, infections and colonization with multidrug-resistant Gram-negative bacteria reduced by 51 percent (incidence ratio [IR], 0.49, 95 percent confidence interval [CI], 0.35–0.68; p<0.0001), while infections and colonization with extended-spectrum β-lactamase-producing Gram-negative bacteria reduced by 48 percent (IR, 0.52, 95 percent CI, 0.27–0.98; p=0.0428). [Lancet Infect Dis 2017;doi:10.1016/S1473-3099(17)30325-0]
Infections and colonization due to methicillin-resistant Staphylococcus aureus (MRSA) and infections due to Clostridium difficile also reduced by 37 and 32 percent, respectively (IR, 0.63; p=0.0065 and IR, 0.68; p=0.0029, respectively).
There was no association between the introduction of antibiotic stewardship programmes and the incidence of vancomycin-resistant enterococci (IR, 1.40; p=0.2233), quinolone-resistant or aminoglycoside-resistant Gram-negative bacteria (IR, 0.74; p=0.1435 and IR, 0.82; p=0.3028, respectively), or quinolone-resistant or aminoglycoside-resistant Gram-positive bacteria (IR, 1.10; p=0.5416 and IR, 1.00; p=0.9701, respectively).
The impact of antibiotic stewardship programmes in reducing antibiotic resistance was more evident when implemented alongside infection control measures (IR, 0.69; p=0.0030 vs IR, 0.81; p=0.0210 when implemented alone), particularly alongside hand-hygiene measures (IR, 0.34; p<0.0001 vs IR, 0.83; p=0.0304 without hand-hygiene measures).
“This finding seems to support the importance of verifying the level of hand-hygiene compliance and adherence to basic infection control measures, with simultaneous implementation of antibiotic stewardship and integration of infection control experts into the antibiotic stewardship programme teams,” said the researchers.
Antibiotic cycling, audits and feedback, and antibiotic restriction were the most effective stewardship measures (IR, 0.49; p=0.0030, IR, 0.66; p=0.0006, and IR, 0.77; p=0.0003, respectively). Conversely, implementing guidelines for stewardship programmes and focusing on one antibiotic class had little impact (IR, 1.03; p=0.7496 and IR, 1.28; p=0.4527, respectively), a finding the researchers attributed to the short follow-up duration in these studies.
The findings were obtained from an analysis of 32 studies conducted between 1992 and 2014 in 20 countries, with the majority of studies coming from the US, Japan, Germany, and France.
Heterogeneity between the studies exceeded 50 percent, primarily driven by bacterial species, resistance patterns, follow-up duration post-antibiotic stewardship programme, concurrent implementation of hand-hygiene measures, and audit and feedback interventions.
“[T]he greatest benefit from stewardship programmes occurs when they are implemented alongside programmes that improve infection control through hand hygiene, highlights the need for governments to develop national action plans that coprioritize antibiotic stewardship and infection prevention,” said Dr Debra Goff from The Ohio State University Wexner Medical Center, Columbus, Ohio, US, and Dr Marc Mendelson from Groote Schuur Hospital, Cape Town, South Africa, in a commentary. [Lancet Infect Dis 2017;doi:10.1016/S1473-3099(17)30344-4]
“The necessity for national action plans to codevelop antibiotic stewardship and infection prevention programmes reaffirms the power of a multidisciplinary approach,” they said.