2017年5月CIDに報告された、アジア太平洋地域における入院患者に対するASP効果の systematic review and meta-ana。
An antimicrobial stewardship program (ASP) is one of the core elements needed to optimize antimicrobial use. Although collaboration at the national level to address the importance of ASPs and antimicrobial resistance has occurred in the Asia Pacific region, hospital-level ASP implementation in this region has not been comprehensively evaluated.
We conducted a systematic review and meta-analysis to assess the efficacy of ASPs in inpatient settings in the Asia Pacific region from January 2005 through March 2016. The impact of ASPs on various outcomes, including patient clinical outcomes, antimicrobial prescription outcomes, microbiological outcomes, and expenditure were assessed.
Forty-six studies were included for a systematic review and meta-analysis. The pooled risk ratio for mortality from ASP before-after trials and 2-group comparative studies were 1.03 (95% confidence interval [CI], .88-1.19) and 0.69 (95% CI, .56-.86), respectively. The pooled effect size for change in overall antimicrobial and carbapenem consumption (% difference) was -9.74% (95% CI, -18.93% to -.99%) and -10.56% (95% CI, -19.99% to -3.03%), respectively. Trends toward decreases in the incidence of multidrug-resistant organisms and antimicrobial expenditure (range, 9.7%-58.1% reduction in cost in the intervention period/arm) were also observed.
ASPs in inpatient settings in the Asia Pacific region appear to be safe and effective to reduce antimicrobial consumption and improve outcomes. However, given the significant variations in assessing the efficacy of ASPs, high-quality studies using standardized surveillance methodology for antimicrobial consumption and similar metrics for outcome measurement are needed to further promote antimicrobial stewardship in this region.
Fig and Tab
We were unable to assess the efficacy of ASPs across all countries in the Asia Pacic region because few published studies were available from these countries. Of note, maximizing access to appropriate antimicrobials remains the most important consideration among the middle- and low-income nations in this region. Furthermore, because some of the included studies were published at the same institutions, portions of the data might have been duplicated and thus led to the overestimation of the ecacy of ASPs. As with many ASPs in other countries or regions, most ASPs in the Asia Paci c region were multifaceted and outcome measurements signi cantly varied in each study. It is di cult to determine which core elements mostly contributed to the success of the ASPs. As seen in Table 2, some studies evaluated the impact of ASPs on antimicrobial-resistant organisms, but the long-term e ects are not clearly understood.