さまよう薬剤師のブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

Antimicrobial Stewardship in Inpatient Settings in the Asia Pacific Region: A Systematic Review and Meta-analysis.

Antimicrobial Stewardship in Inpatient Settings in the Asia Pacific Region: A Systematic Review and Meta-analysis.

 

www.ncbi.nlm.nih.gov

 

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

 

 

 

Abstract

 

BACKGROUND:

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.

METHODS: 

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.

RESULTS: 

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.

CONCLUSIONS: 

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

 

f:id:akinohanayuki:20170620051407p:plain

 

f:id:akinohanayuki:20170620051446p:plain

 

f:id:akinohanayuki:20170620051502p:plain

 

Limitations

 

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.

 

感想

 

ASPが好ましい方向の結果で、良かったです。

 

良い結果が得られそうな前後試験において死亡率に差がなく、2グループ比較試験は死亡率に差があったことは、試験デザインの再考する必要性を感じてます。

 

前後比較の試験デザインは、時代進化というバイアスがかかるが、研究しやすいです。

一方、2グループ比較試験は、診療科別の比較なのか、他病院との比較なのか、こちらもバイアス排除が難しいです。

 

著者の限界にも記載してありますが、評価のばらつきについても、課題ですね。

 

ASP研究もメタアナがLancetやCIDから出てきたことで、次のステップに移っていきます。これからの展開が楽しみですね。

 

 私は転勤族なので、各施設の特徴を生かしたASP論文を、書いていきたいですね。

 

akinohanayuki.hatenablog.com

 

akinohanayuki.hatenablog.com