Systematic review of antimicrobial drug prescribing in hospitals

Area of Science:

• Health Services Research
• Infectious Diseases
• Clinical Pharmacy

Background:

• Antimicrobial drug resistance and healthcare-associated infections are significant public health concerns.
• Prudent antimicrobial prescribing is a key strategy to mitigate these issues in hospital settings.

Purpose of the Study:

• To systematically review rigorous evaluations of interventions aimed at improving antimicrobial drug prescribing in hospitals.
• To assess the impact of these interventions on microbiologic outcomes.

Main Methods:

• Literature search from January 1980 to November 2003 for studies evaluating interventions to improve hospital antimicrobial prescribing.
• Analysis of 66 studies with interpretable data, focusing on 20 microbiologic outcomes from 16 studies.
• Categorization of evidence strength based on the impact of interventions on microbial outcomes.

Main Results:

• Sixteen studies reported on microbiologic outcomes, including gram-negative resistant bacteria, Clostridium difficile-associated diarrhea (CDAD), vancomycin-resistant enterococci, and methicillin-resistant Staphylococcus aureus.
• Four studies provided strong evidence of intervention effectiveness; eight provided less convincing evidence; four provided no evidence.
• The strongest evidence supported interventions for CDAD, though only immediate impacts could be analyzed due to varied follow-up durations.

Conclusions:

• Interventions to improve antimicrobial prescribing show promise, particularly for reducing CDAD.
• Standardization of study methods and reporting is crucial for enhanced comparability and stronger evidence synthesis.
• Further research with standardized protocols is needed to fully evaluate the long-term impact of antimicrobial stewardship interventions.