成人院内肺炎における抗菌薬適正使用介入：系統的レビューおよびメタアナリシス

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), represents one of the most severe healthcare-associated infections (HAIs), characterized by high morbidity, mortality, and antimicrobial resistance (AMR) rates.

To systematically assess the impact of antimicrobial stewardship and diagnostic interventions on clinical, microbiological, and process outcomes in adult patients with HAP/VAP.

A systematic review and meta-analysis were performed according to PRISMA 2020 guidelines (PROSPERO: CRD42023492494). PubMed, Scopus, and Web of Science databases were searched for studies published from 2000 to May 2025. Eligible designs included randomized trials, quasi-experimental, and before-after studies involving adults with HAP or VAP. Pooled odds ratios (OR) and standardized mean differences (SMD) were estimated using random effect models in R (meta package).

Nineteen studies were included, of which eleven were meta-analyzed. ASP interventions significantly reduced the duration of antibiotic therapy (SMD = -1.02; 95% CI: -1.76 to -0.28; p = 0.007). A significant improvement was also observed for protocol adherence (OR = 5.91; 95% CI: 1.26-27.67; p = 0.024). No statistically significant differences were found for hospital mortality (OR = 0.73; 95% CI: 0.51-1.05; p = 0.088), 30-day in-hospital mortality (OR = 1.13; 95% CI: 0.73-1.76; p = 0.58), length of ICU stay, or ventilator-free days. Heterogeneity was high across designs.

Stewardship interventions for HAP/VAP safely shorten antibiotic duration and improve adherence to clinical protocols without compromising patient safety. To achieve more meaningful clinical impact, future ASP models should integrate diagnostics, PK/PD-guided dosing, and ventilator-care bundles within multidisciplinary ICU frameworks.