The Impact Of Antibiotic Stewardship Programs In Asia: A Systematic Review And Meta-analysis

Abstract

Introduction: The use of antimicrobial stewardship programs (ASPs) is increasing in Asia but their effectiveness in reducing the consumption of antibiotics and their impact on clinical outcomes is not known. Objectives: To review published data on the consumption of antibiotics and the impact on clinical outcomes of ASPs conducted in Asia. Methods: We conducted a systematic search in the Embase and Medline (PubMed) databases for studies that compared the consumption of antibiotics or clinical outcomes of patients in an Asian hospital or clinic with an ASP (intervention group) with those in a similar setting without an ASP (control group). Meta-analyses of all-cause mortality and hospital-acquired infection (HAI) were performed using random-effects models. Results: The search identified 77 studies of which 22 and 19 reported on antibiotic usage and cost, respectively. Among these, 20 (91%) studies reported reduced antibiotic usage and 19 (100%) reported cost savings in the intervention group compared to the control. Duration of antibiotic therapy was reported in 7 studies; all but one reported that duration was reduced in association with an ASP. In the meta-analyses, rates of all-cause mortality and HAI were not significantly different between the intervention and control groups, but mortality rates were significantly improved by ASPs using drug monitoring, while HAI rates were also improved by ASPs that included infection control or hand hygiene programs. Conclusion: ASPs reduce the consumption of antibiotics in hospital and clinic settings and are not associated with worse clinical outcomes. The findings support the broad implementation of antimicrobial stewardship interventions conducted in hospital and clinic setting in Asia.