In the Journals Plus

Antimicrobial stewardship programs significantly reduce drug-resistant bacteria

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July 11, 2017

Antibiotic stewardship programs, or ASPs, have been shown to reduce antibiotic use and hospital costs, but a recently published meta-analysis in The Lancet Infectious Diseases showed that ASPs have a substantial impact on the incidence of infections and colonization with antimicrobial-resistant bacteria and Clostridium difficile as well.

“In view of the increasing number of infections caused by antibiotic-resistant bacteria, restriction of unnecessary antibiotic use and optimization of infection control measures are of the utmost importance,” David Baur, MD, from the division of infectious disease at Tübingen University Hospital in Germany, and colleagues wrote. “Four systematic reviews and meta-analyses have summarized the evidence of the effects of [ASPs] in hospital inpatients. Despite the importance of antibiotic resistance, the effect of [ASPs] on the incidence of antibiotic-resistant bacteria has not yet been systematically reviewed.”

Baur and colleagues reviewed 32 studies published from Jan. 1, 1960, to May 31, 2016. The studies focused on how ASPs affected the incidence of infection and colonization with antibiotic-resistant bacteria and C. difficile among inpatients.

Under ASPs, gram-negative bacteria incidence fell by more than half (51%; P < .0001), Baur and colleagues wrote. The researchers reported that extended-spectrum beta-lactamase-producing gram-negative bacteria incidence fell by 48% (P = .0428), MRSA decreased by 37% (P = .0065) and the incidence of C. difficile fell by nearly one third (32%; P = .003).

ASPs tended to be more effective when they were implemented alongside infection control measures than when they were put in action without other interventions, the researchers wrote (incidence ratio [IR] = 0.69; 95% CI, 0.54-0.88), particularly when those interventions included hand hygiene measures (IR = 0.34; 95% CI, 0.21-0.54).

Debra A. Goff

However, ASPs had no effect on IRs of quinolone-resistant or aminoglycoside-resistant gram-negative bacteria; nor did they have an effect on vancomycin-resistant enterococci.

In an accompanying editorial, Debra A. Goff, PharmD, FCCP, from The Ohio State University Wexner Medical Center, and Marc Mendelson, PhD, MBBS, FRCP, of Groote Schuure Hospital, University of Cape Town, South Africa, wrote that the study “highlights the need for governments to develop national action plans that co-prioritize antibiotic stewardship and infection prevention.

“The results of Baur and colleagues’ meta-analysis are an important advocacy tool, and one that we should use in support of developing winning teams,” they wrote. “If we get antibiotic stewardship right, the real winner will be the patient who avoids infection by a drug-resistant bacterium or C. difficile, now and in the future, as we preserve antibiotics for generations to come.” – by Andy Polhamus

Disclosures: Goff and Mendelson report no relevant financial disclosures. The researchers report no relevant financial disclosures.

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Reductions in bacterial infections under antimicrobial stewardship programs

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