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Nudging in MicroBiology laboratory Evaluation (NiMBLE): a systematic review and meta-analysis
Bradley J Langford1, Elizabeth Leung2, Esther Jeong3
1Public Health Ontario, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada.
Summary
Nudging strategies in microbiology reports significantly improved antimicrobial prescribing appropriateness and utilization. These findings support integrating nudges into antimicrobial stewardship programs (ASPs) to optimize antimicrobial use.
Area of Science:
- Health Services Research
- Infectious Diseases
- Clinical Microbiology
Background:
- Antimicrobial stewardship programs (ASPs) aim to optimize antimicrobial use through various strategies.
- Selective or cascade reporting of antimicrobial susceptibility results are recommended nudging techniques within ASP guidelines.
- These nudges modify choice architecture to guide prescribing behavior without restricting clinician autonomy.
Purpose of the Study:
- To systematically review and meta-analyze the impact of nudging in microbiology reports on antimicrobial prescribing and clinical outcomes.
- To evaluate the effectiveness of different nudging strategies, including selective, framing, and eye-level reporting.
Main Methods:
- A systematic search of four databases was conducted following a PROSPERO-registered protocol.
- Included studies evaluated clinical microbiology report nudges affecting prescribing or clinical outcomes in human participants across all healthcare settings.
- Random-effects meta-analysis was used to pool reported outcomes, with risk of bias assessed using standard tools.
Main Results:
- Analysis of 45 studies (from 36,339 records) showed nudging interventions increased prescribing appropriateness by 143% (OR = 2.43).
- Nudging reduced antimicrobial utilization by 1.70 days of therapy.
- No significant increase in harm was observed; mortality and C. difficile infection rates remained unaffected.
Conclusions:
- Nudging in microbiology reports is an effective strategy for improving antimicrobial appropriateness and utilization.
- These findings support the integration of nudging techniques into antimicrobial stewardship programs (ASPs).
- Future research should focus on prospective designs to further evaluate clinical outcomes, sustainability, and generalizability.
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