|Year : 2020 | Volume
| Issue : 1 | Page : 11-15
Inclining trend of the researchers interest in antimicrobial stewardship: A systematic review
Nehad J Ahmad1, Abdullah U Althemery2, Abdul Haseeb3, Reham F Yusuf4, Azmi Ahmed Hassali5, Amer H Khan6
1 Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Penang, Malaysia; Clinical Pharmacy Department, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
2 Clinical Pharmacy Department, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
3 Clinical Pharmacy Department, College of Pharmacy, Umm AlQura University, Mecca, Saudi Arabia
4 College of Pharmacy, University of Jordan, Amman, Jordan
5 Discipline of Social Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Penang, Malaysia
6 Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Penang, Malaysia
|Date of Submission||05-Aug-2019|
|Date of Decision||06-Sep-2019|
|Date of Acceptance||09-Nov-2019|
|Date of Web Publication||29-Jan-2020|
Mr. Nehad J Ahmad
Mr. Nehad J. Ahmed, Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj.
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: The implementation of antibiotic stewardship programs (ASPs) can improve the treatment of infections and can decrease the adverse events that result from antibiotics use. In the last decades, there is an increasing interest of the researchers in the implementation of ASPs. Materials and Methods: The articles published in different journals were retrieved by searching many research databases such as Cochrane library, Europe PMC, PubMed, and Web of Science; we searched these databases for all published articles till November 2018. Results and Discussion: The searching results using Cochrane library showed an increase in the number of randomized clinical trials that related to the keyword of “antimicrobial stewardship” specially in the last 5 years.Using Europe PMC, we found 6178 results. From these results, there are 3874 free full texts. In addition, there are 2132 original articles in PubMed and by searching Web of Science database till November 8 there are 3085 results.These results show that the number of trusted published articles was increased continuously; this shows the increasing interest of the researchers in ASPs. These researches will help health-care providers to use antibiotics appropriately and to overcome the barriers of implementing ASPs. Conclusion: The results of this study show that the researchers had high levels of interest in participating in research activities related to the appropriate use on antibiotics and the implementation of antimicrobial stewardship programs.
Keywords: Antibiotic stewardship programs, antimicrobial, programs, stewardship
|How to cite this article:|
Ahmad NJ, Althemery AU, Haseeb A, Yusuf RF, Hassali AA, Khan AH. Inclining trend of the researchers interest in antimicrobial stewardship: A systematic review. J Pharm Bioall Sci 2020;12:11-5
|How to cite this URL:|
Ahmad NJ, Althemery AU, Haseeb A, Yusuf RF, Hassali AA, Khan AH. Inclining trend of the researchers interest in antimicrobial stewardship: A systematic review. J Pharm Bioall Sci [serial online] 2020 [cited 2020 Sep 26];12:11-5. Available from: http://www.jpbsonline.org/text.asp?2020/12/1/11/277201
| Introduction|| |
Antibiotics have improved practice of medicine. They help in treating severe infections and augment advances in the medical field such as reducing likelihood of infections during organ transplants and cancer chemotherapy. The early initiation of antibiotics has been proven to decrease the mortality and morbidity rate of the infections, such as in the treatment of sepsis. However, in acute care hospitals in the U.S. about 20%–50% of all antibiotic prescriptions either are not appropriate or are unnecessary.,,,,,
One of the major problems that results from the inappropriate use of antibiotics is the emergence of antibiotic resistance, which is considered one of the serious threats to the public health. According to the Centers for Disease Control and Prevention (CDC), it is estimated that more than 2 million people are infected with antibiotic-resistant organisms. This increase in the number of patients infected with antibiotic-resistant organisms results in high mortality rate annually (approximately 23,000 deaths each year).
Nowadays, the improvement of antibiotic use is an important issue that affects the safety of the patient and the public health. Also it is considered as an important national priority. The first educational effort was launched by CDC to improve the use of antibiotics in acute care hospitals in 2009. The CDC in 2013 stated that there is a need for the improvement of antibiotic use. This improvement of antibiotic use is considered as an important strategy required to solve the problem of increasing emergence of antibiotic resistance problem in the U.S.
The beginning of the implementation of hospital-based programs referred to as “antibiotic stewardship programs” (ASPs) can lead to positive outcomes. These programs improve the treatment of infections and decrease the adverse events that can be results from the use of antibiotics.,
The implementation of these programs helps in improving the quality of care that will be given to the patient. Moreover, this implementation results in improving the patient safety by increasing the cure rates of infections, decreasing the failures of the treatment, and increasing the rate of correct prescribing., They also decrease hospital rates of infections caused by clostridium difficile significantly,, and decrease the rate of antibiotic resistance., In addition to that, these programs also save the hospitals money.,,,
In the last decades, there is an increasing interest of the public, the health-care professionals, and the researchers in the use of antibiotics. As a part of that, there is an increasing interest in the implementation of antimicrobial stewardship programs.
The aim of this study was to show the increasing interest of the researchers in antimicrobial stewardship programs in recent years.
| Materials and methods|| |
The articles published in different journals were retrieved by searching many research databases such as Cochrane library, Europe PMC, PubMed, and Web of Science.
The principal parameters analyzed were the number of articles published in different databases, the comparison between different years regarding the number of the publications, the category of the publications, and the citation of publications.
The primary search used four major search engines. The first part contains the searching results using Cochrane library. The second part contains the searching results using Europe PMC. The third part contains the searching results using PubMed. The fourth part contains the searching results using Web of Science.
We include only articles related to antimicrobial stewardship; we excluded books, preprints, reviews, and clinical answers. The tables for the results were prepared using Microsoft Excel® 2016, Washington, US.
I review the CASP checklist to make critical appraisal for the review articles. This checklist includes 10 questions in three main Sections.
Section A: Are the results of the study valid?
- I think the results of this review are valid because:
- The review addresses a clearly focused question.
- The right type of papers was looked for using original article from well-known secondary resources.
- I think that all of the important, relevant studies were included.
- The papers published in a well-known secondary resource that publishes papers with good quality.
- It reasonable to combine the results of the review.
Section B: What are the results?
The results showed that there is an increasing interest in antimicrobial stewardship program researches that will lead to the usage of antibiotics appropriately. The results were expressed by numbers and percentages.
Section C: Will the results help locally?
The results can be applied to the local population to improve the use of antibiotics. In addition, the review do not include any interventions so the benefits worth the harms and costs.
| Results|| |
By searching Cochrane library in November 5, 2018, we included controlled trials and excluded reviews and clinical answers. Out of 134 searching results, there were 133 clinical trials. From these trials, 47 trials were added to central trial database in the last 2 years and 94 trials were added in the last 4 years.
Embase is the source of 78 antimicrobial stewardship trials in Cochrane library databases. The number of trials that were published in the last 5 years in Cochrane library database about antimicrobial stewardship is shown in [Table 1].
|Table 1: Searching Cochrane library about the antimicrobial stewardship trials|
Click here to view
The second part comprised searching Europe PMC. Till November 15, we found 6178 results from these results and of these 3874 were free full-text articles. The year of the highest percentage was 2017; in this year there were 961 full-text articles published in Europe PMC database. Of these, 3874 were free full-text articles, and 3100 articles were published after 2013. The number of trials that were published in Europe PMC database about antimicrobial stewardship after 2013 is shown in [Table 2].
|Table 2: Searching Europe PMC about the antimicrobial stewardship publications|
Click here to view
The third part comprised the results for searching PubMed. Since 1996 till November 15, 2018, there were 2853 articles in PubMed. These 2853 articles included 721 review articles, so after excluding the review articles the total number of original articles was 2132.
The year for the highest publications was 2018. From the beginning of 2018 till November 15, 2018, there were 586 original articles and 123 reviews in PubMed for “antimicrobial stewardship” keyword. Only 34 original researches were published before 2009. [Table 3] represents the distribution of different searching results and the number of published articles about AS using PubMed.
|Table 3: The number of the published articles about antimicrobial stewardship in PubMed since 1996|
Click here to view
The fourth part comprised the results for searching Web of Science. Till November 8 there were 3085 results. Of these results 1275 were Open Access. After 2010, there were more than 100 publications each year. Since 2013 till November 8, 2018, there were 2567 publications (83.20%).
The main Web of Science categories are infectious diseases 1502 results and microbiology 802 results. The main document type is article (2134 of 3085). [Table 4] represents the types of Web of Science documents.
Of the 3085 results, there were 2134 original articles (including only original articles and excluding reviews, editorial materials, meeting abstracts, letters, and other documents).
| Discussion|| |
There is an increasing interest of the researchers in antimicrobial stewardship programs. The results showed that there was an increase in the number of publications during the last several years.
In the first part “searching Cochrane library” in November 5, 2018, there were 133 trials matching on “antimicrobial stewardship” keyword. The majority of these trials published after 2013. This result showed that each year there was an increased number of publications related to antimicrobial stewardship especially in 2016 and 2017.
The second part included searching Europe PMC, and a total of 6178 results were found. The highest number on publications in 1 year was in 2017. Of 6178 articles, 961 were in 2017 (17.12%).
The third part included searching PubMed since 1996 till November 15, 2018. The results showed that there were 2853 published papers in PubMed. The number of publications increased continuously since 1996 (the first published article in 1996). The year for the highest publications is 2018. Till November 15, 2018, there were 586 original articles and 123 were reviews in PubMed for “antimicrobial stewardship” keyword.
After 2012 till November 15, 2018, the number of original articles that were published yearly is more than 100. For example, the number of publications (excluding reviews) in the last 7 years is 134 in 2013, 165 in 2014, 213 in 2015, 324 in 2016, 478 in 2017, and 586 in 2018.
In the fourth part, we used Web of Science to find the searching results for the keyword “antimicrobial stewardship,” we collected the data in November 8, 2018. Till November 8, there were 3085 results from different types. The results show that the number of publications are increasing continuously especially during the last several years. After 2010, there were more than 100 publications annually. Since 2013 till November 8, 2018, there were 2567 publications (83.20% of the publications were published after 2012).
The main Web of Science categories for our research are infectious diseases, microbiology, pharmacy/pharmacology, public environmental occupational health, and immunology. The majority of these publications were original articles (69.17 %) followed by review articles (15.26%).
The number of citations for 37 articles was more than 100 times. One of the publications (Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship) was cited 1571 times. This shows the importance of the appropriate use of antibiotics by implementing antimicrobial stewardship programs. In addition, this also shows the importance of continuous research activities that are related to these programs to help in optimizing the use of antibiotics
These results show that the health-care providers are interested in implementing antimicrobial stewardship programs and the researchers are interested in studying these programs to improve ASP implementation and to decrease the gaps and barriers for its implementation
| Conclusion|| |
There is an increasing interest in ASP researches, especially during the last several years. The results of this review study show that the researchers had high level of interest in the participation in research activities related to the appropriate use of antibiotics and the implementation of antimicrobial stewardship programs. This interest is very important to help the health-care providers in prescribing and dispensing antibiotic correctly and to solve the problem of antimicrobial resistance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al
; Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39:165-228.
Levin PD, Idrees S, Sprung CL, Weissman C, Weiss Y, Moses AE, et al
. Antimicrobial use in the ICU: Indications and accuracy––an observational trial. J Hosp Med 2012;7:672-8.
Patel SJ, Oshodi A, Prasad P, Delamora P, Larson E, Zaoutis T, et al
. Antibiotic use in neonatal intensive care units and adherence with centers for disease control and prevention 12 step campaign to prevent antimicrobial resistance. Pediatr Infect Dis J 2009;28:1047-51.
Camins BC, King MD, Wells JB, Googe HL, Patel M, Kourbatova EV, et al
. Impact of an antimicrobial utilization program on antimicrobial use at a large teaching hospital: A randomized controlled trial. Infect Control Hosp Epidemiol 2009;30:931-8.
Ingram PR, Seet JM, Budgeon CA, Murray R. Point-prevalence study of inappropriate antibiotic use at a tertiary Australian hospital. Intern Med J 2012;42:719-21.
Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, et al
; Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious diseases society of America and the society for healthcare epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159-77.
Fridkin S, Baggs J, Fagan R, Magill S, Pollack LA, Malpiedi P, et al
; Centers for Disease Control and Prevention (CDC). Vital signs: Improving antibiotic use among hospitalized patients. MMWR Morb Mortal Wkly Rep 2014;63:194-200.
Huttner A, Harbarth S, Carlet J, Cosgrove S, Goossens H, Holmes A, et al
. Antimicrobial resistance: A global view from the 2013 world healthcare-associated infections forum. Antimicrob Resist Infect Control 2013;2:31.
Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States. Atlanta (GA): CDC2013.
Centers for Disease Control and Prevention. CDC’s top ten: 5 health achievements in 2013 and 5 health threats in 2014; 2013. Available from: http://blogs.cdc.gov/cdcworksforyou24-7/2013/12/cdc%e2%80%99s-top-ten-5-health-achievements-in-2013-and-5-health-threats-in-2014/. [Last accessed on 2014 Feb 24].
Centers for Disease Control and Prevention. Get smart: Know when antibiotics work. Available from: https://www.cdc.gov/antibiotic-use/healthcare/. [Last accessed on 2014 Feb 24].
Davey P, Brown E, Charani E, Fenelon L, Gould IM, Holmes A, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2013;4:CD003543.
Malani AN, Richards PG, Kapila S, Otto MH, Czerwinski J, Singal B. Clinical and economic outcomes from a community hospital’s antimicrobial stewardship program. Am J Infect Control 2013;41:145-8.
Stach LM, Hedican EB, Herigon JC, Jackson MA, Newland JG. Clinicians’ attitudes towards an antimicrobial stewardship program at a children’s hospital. J Pediatric Infect Dis Soc 2012;1:190-7.
Kaki R, Elligsen M, Walker S, Simor A, Palmay L, Daneman N. Impact of antimicrobial stewardship in critical care: A systematic review. J Antimicrob Chemother 2011;66:1223-30.
Nowak MA, Nelson RE, Breidenbach JL, Thompson PA, Carson PJ. Clinical and economic outcomes of a prospective antimicrobial stewardship program. Am J Health Syst Pharm 2012;69:1500-8.
Bishop J, Parry MF, Hall T. Decreasing clostridium difficile infections in surgery: impact of a practice bundle incorporating a resident rounding protocol. Conn Med 2013;77:69-75.
Leung V, Gill S, Sauve J, Walker K, Stumpo C, Powis J. Growing a “positive culture” of antimicrobial stewardship in a community hospital. Can J Hosp Pharm 2011;64:314-20.
Valiquette L, Cossette B, Garant MP, Diab H, Pépin J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis 2007;45:S112-21.
DiazGranados CA. Prospective audit for antimicrobial stewardship in intensive care: Impact on resistance and clinical outcomes. Am J Infect Control 2012;40:526-9.
Elligsen M, Walker SA, Pinto R, Simor A, Mubareka S, Rachlis A, et al
. Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients: A controlled interrupted time series analysis. Infect Control Hosp Epidemiol 2012;33:354-61.
Griffith M, Postelnick M, Scheetz M. Antimicrobial stewardship programs: Methods of operation and suggested outcomes. Expert Rev Anti Infect Ther 2012;10:63-73.
Roberts RR, Hota B, Ahmad I, Scott RD 2nd, Foster SD, Abbasi F, et al
. Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: Implications for antibiotic stewardship. Clin Infect Dis 2009;49: 1175-84.
Sick AC, Lehmann CU, Tamma PD, Lee CK, Agwu AL. Sustained savings from a longitudinal cost analysis of an internet-based preapproval antimicrobial stewardship program. Infect Control Hosp Epidemiol 2013;34:573-80.
Standiford HC, Chan S, Tripoli M, Weekes E, Forrest GN. Antimicrobial stewardship at a large tertiary care academic medical center: Cost analysis before, during, and after a 7-year program. Infect Control Hosp Epidemiol 2012;33:338-45.
Anon; 2018. Available from: https://www.cochranelibrary.com. [Last accessed on 2018 Nov 21].
Europe PMC; 2018. Available from: https://europepmc.org. [Last accessed on 2018 Nov 21].
Home – PubMed – NCBI; 2018. Available from: https://www.ncbi.nlm.nih.gov/pubmed. [Last accessed on 2018 Nov 21].
Web of science; 2018. Available from: https://www.webofknowledge.com [Last accessed on 2018 Nov 21].
Critical Appraisal Skills Programme. CASP Systematic Review Checklist; 2018.
[Table 1], [Table 2], [Table 3], [Table 4]