Abstract
Hospitals continue to face challenges in reducing incorrect antibiotic use due to social and cultural factors at the level of the health system, the care facility, the provider, and the patient. The objective of this paper is to highlight the social and cultural drivers of antimicrobial use and resistance and targeted interventions for secondary and tertiary care settings in Canada and other OECD countries. This paper is an extension of the synthesis conducted for the Public Health Agency of Canada's 2019 Spotlight Report: Preserving Antibiotics Now and Into the Future. We conducted a systematic review with a few modifications to meet rapid timelines. We conducted a search in Ovid MEDLINE and McMaster University's evidence databases for systematic reviews and then for individual Canadian studies. To cast a wider net, we searched OECD organization websites and screened reference lists from systematic reviews. We synthesized the evidence narratively and categorized the evidence into macro-, meso-, and microlevel. A total of 70 studies were (a) from OCED countries and summarized evidence of potential sociocultural antimicrobial resistance and use barriers or facilitators and/or interventions addressing these challenges; (b) systematic reviews with 50% of included studies that are situated in secondary and tertiary settings; and (c) published in Canada's two official languages, English and French. We found that hospital structures and policies may influence antibiotic utilization and variations in antimicrobial management. Microlevel factors may sway inappropriate prescribing among clinicians. The amount and type of antibiotics used may affect resistance rates. Interventions were mainly comprised of antibiotic stewardship and training that modify clinician behavior and that educate patients and carers. This evidence synthesis illustrates the various drivers of, and interventions for, antimicrobial use and resistance at the macro-, meso-, and microlevel in secondary and tertiary settings. We demonstrate that upstream drivers may lead to downstream events that influence antimicrobial resistance.
Highlights
Inappropriate use of antimicrobials and the lack of new classes of antibiotics have reduced our ability to manage antimicrobial or antibiotic resistance (AMR or ABR) [1, 2].Despite previous e orts to manage AMR through infection prevention and control practices and antimicrobial stewardship programs, AMR is threatening global health and the world’s sustainable development goals [3]
The Public Health Agency of Canada’s report focused on primary care settings, our search included evidence on secondary and tertiary care settings. is paper synthesizes the evidence from secondary and tertiary care settings, which includes hospital wards, emergency departments, and hospital inpatient pharmacies. e protocol for this rapid evidence synthesis is registered in PROSPERO. is paper is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines
We organized studies by outcome, from which two themes emerged: we identified outcomes that relate to antimicrobial use and antimicrobial resistance
Summary
Inappropriate use of antimicrobials and the lack of new classes of antibiotics have reduced our ability to manage antimicrobial or antibiotic resistance (AMR or ABR) [1, 2]. Despite previous e orts to manage AMR through infection prevention and control practices and antimicrobial stewardship programs, AMR is threatening global health and the world’s sustainable development goals [3]. In 2018, AMR reduced Canada’s gross domestic product by $2.8 billion. By 2050, this number is projected to increase to $13 billion or more if resistance rates increase [6]. In response to this global health crisis, the United Nations and its member states committed to tackle AMR sustainably and across the human, animal, and environmental reservoirs [7, 8]
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Schedule a callMore From: The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale
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