Abstract
Background: In low-and middle-income countries (LMICs), infectious diseases burden and increased rates of antimicrobial use, make the implementation of antimicrobial stewardship (AS) an indispensable choice. The study aimed to demonstrate the characteristics of AS interventions and to assess their impact on antibiotic, economic and clinical outcomes among hospitalized patients in LMICs. Methods: data from studies reporting the efficacy of hospital AS interventions and their impact on antibiotic, economic and/or clinical outcomes across LMICs were collected and interpreted. The data from the same outcomes were pooled and analysed using a random-effects meta-analysis model. Results: The antimicrobial consumption showed a 14.8% reduction (95% CI: 3.02 to 1.82, I2: 94.8%, p < 0.001). No evidence of small-study effect across studies was detected (Egger’s regression: 3.2, p-value 2-tailed: 0.12). The antimicrobial consumption was decreased by 1.1% (95% CI: 1.34 to 0.54, I2: 97.3%, p < 0.001). The implementation of AS has led to decrease in antimicrobial cost of 2.4% (95% CI: 1.47 to 1.27, I2: 92.6%, p < 0.001). The mean hospital length of stay was reduced by 19.1% (95% CI: 5.99 to 0.61, I2: 97.7%, p < 0.001). Conclusion: All the investigated interventions succeeded to positively affect the targeted outcomes. Education was not underscored as an AS intervention, with complete absence of behavioural elements. Antimicrobial exposure/use/consumption is the most commonly used outcome indicator. For economic and LoS concerned studies, more data is needed to provide a stronger business case to encourage investing in AS. Limited data on AS interventions in LMICs entails urgent attention.
Highlights
The global continuous surge in drug resistant infections has been associated with the increasing use of antimicrobials worldwide, which impends to return back to the pre-antibiotic era [1]
The scenario is more dramatic in low- and middle-income countries (LMICs) where a higher burden of infectious diseases has been reported [2]
All published studies conducted in low-and middle-income countries (LMICs) and reporting the efficacy of hospital antimicrobial stewardship (AS) interventions and their impact were included in this analysis
Summary
The global continuous surge in drug resistant infections has been associated with the increasing use of antimicrobials worldwide, which impends to return back to the pre-antibiotic era [1]. The scenario is more dramatic in low- and middle-income countries (LMICs) where a higher burden of infectious diseases has been reported [2]. Adding to the limited resources and poor infrastructure of healthcare facilities, Antibiotic stewardship (AS) programs data from LMICs is scarce and fragmented [3]. Antibiotic stewardship has been developed as a comprehensible set of interventions and actions. In low-and middle-income countries (LMICs), infectious diseases burden and increased rates of antimicrobial use, make the implementation of antimicrobial stewardship (AS) an indispensable choice. The antimicrobial consumption was decreased by 1.1% (95% CI: 1.34 to 0.54, I2: 97.3%, p
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