Table 2.
Study Reference No. | Countries | Settings, Design, Time, and Health Personnel Involved | Interventions | Outcome Measured | Impact |
---|---|---|---|---|---|
Wang et al (2019)156 | China | Tertiary hospital. A retrospective observational study. 2011 to 2016 Pharmacists |
Multi-aspect interventions: activity program, performance management, and training. | Antibiotic prescriptions, the intensity of consumption, antibiotic prophylaxis, and resistance rates | ↓Prescriptions: outpatients - 19.38% to 13.21%, inpatients −64.34% to 34.65%. ↓Intensity: 102.46 to 37.38 DDDa/100 PDb ↓Prophylaxis: 98.94% to 18.93%. ↓Resistance ratesc ↓MRSAd incidence: 68.0% to 37.5% ↑Resistance ratese |
Xiao et al (2020)161 | China | Secondary and tertiary hospitals A retrospective observational study. 2010 to 2016 |
AMS campaign | Antibiotic prescriptions, intensity of consumption, antibiotic expense, and resistance rates | ↓Prescription: outpatients - 19.5% to 8.5%; surgical patients - 97.9% to 38.3%. ↓Intensity: 85.3% to 48.5% DDD/100 bed-days. ↓Antibiotic procurement costs:22.3% to12.1%. ↓Resistance ratesf: 30.8% to 22.3% ↓MRSA incidence: 54.4% to 34.4% |
Mardani et al (2020)162 | Iran | Tertiary teaching hospitals. An interventional quasi-experimental study. Before (2017 to 2018) and after (2018 to 2019) ASP implementation. Nurses and physicians. |
AMS educational programs | Antibiotic prescriptions, the occurrence of CDI, and positive MDR cases | ↓Prescriptiong: 22,464 to 17,262 g. ↓CDIh incidence: 11.2% to 2.7% cases per 10,000 patient days ↓MDRi cases: 145 t0 75 |
Onorato et al (2020)163 | Italy | Intensive care units (ICUs) of a teaching hospital. Prospective, interventional, Interrupted time-series study. Time: 2017–2018. |
Antibiotic prescriptions, incidence of BSI, hospital mortality rate, mean LOS, and antibiotic expense. | ↓Prescription: 324.8 DDD/100 PD ↓Incidence of BSIj: 5.8 events/100 PD Hospital mortality rate: No difference Mean LOSk: No difference |
|
Savoldi et al (2020)164 | Germany | Prospective quasi-experimental, Interrupted time-series study. Tertiary care teaching hospital. 2014 and 2017. |
Non-restrictive ASP, 3 phases: 1-year pre-intervention, 2-year multifaceted intervention, and one year of post-intervention. | Antibiotic prescriptions, antibiotic expense, mean LOS, CDI incidence rate, and mortality in the patients’ group were admitted from ED to medical wards. | ↓Prescription: 31.1% to 7.2% DDD/100 PD. ↓Incidence of CDI ↓Mean LOS Mortality rate: No difference ↓Antibiotic expense: 691.5 to 263.3 EUROs/100 PDs |
Singh et al (2018)165 | India | Tertiary teaching hospital. Quasi-experimental study. 2015 to 2017. Infection control team |
Post-prescriptive audit and establishment of institutional guidelines | Antibiotic prescriptions, antibiotic expense, compliance with ASP Recommendations | ↓Prescription (DDD/100 PD). ↓Mean monthly cost for restricted drugs by 14.4% ↑Compliance: 54% |
Wee et al (2020)166 | Singapore | Tertiary teaching hospital. A retrospective cohort studies. 2016 to 2018. |
Prospective audit and feedback strategy | Adherence to ASP recommendations | ↑Adherence: 81.9% (5758/7028) |
Abubakar et al (2019)167 | Nigeria | Tertiary hospitals. Prospective pre- and post-intervention study. May and December 2016. Pharmacists. |
Development of a protocol, educational meeting and audit and feedback | Antibiotic prescriptions, the intensity of consumption, antibiotic expense, and resistance rates | ↓Prescription: 19.1% ↓Prescription: third generation cephalosporin (−8.6%), ↓Intensity: (3.8 DDD/procedure) ↓Cost: $4.2/procedure ↑Compliance: Timing (14.2% to 43.3%) and duration (0% to 21.8%) |
Brink et al (2017)168 | South Africa | Private hospitals. Prospective pre- and post-intervention study. Pharmacist. 2013–2015. |
Prospective audit and feedback for perioperative antibiotic prophylaxis | SSI and compliance. | ↑Compliance: 66.8% to 83.3% (95% CI 80.8–85.8). ↓SSIl rate 19.7% |
Horikoshi et al (2017)155 | Japan | Tokyo Metropolitan Children’s Medical Center. Prospective pre- and post-intervention study. Quasi-experimental study. 2010–2017. |
Computerized preauthorization and a prospective audit, an electronic chart-based drug ordering system | DOT in the post-intervention period, the resistance rate, and the correlation between DOT and resistance rates, average days of hospitalization, all-cause mortality, and infection-related mortality in the pre- and post-intervention periods. | ↓DOTm in the post-intervention period: 59.3% ↓The resistance rate: 72.2% ↑positive correlation ↓Average hospitalization (days) ↓All-cause mortality rate (per 1000 patient-days) ↓Infection-related mortality rate (per 1000 patient-days) |
D’Agata et al (2018)169 | USA | Outpatient dialysis facilities. Quasi-experimental study. 2015–2016 |
ASP | Rates of antimicrobial use per 100 patient months, rates of use for specific antimicrobials or antimicrobial groups. | ↓Antimicrobial doses per 100 patient months: 6% |
Notes: cE. coli and P. aeruginosa to fluoroquinolones. eE. coli and K. pneumoniae to carbapenems. fCarbapenem-resistant Pseudomonas aeruginosa isolates. gMeropenem prescriptions. hClostridium difficile infections. ↑: Increase. ↓: Decrease.
Abbreviations: aPD, patient-days; bDDD, defined daily doses; dMRSA, methicillin-resistant Staphylococcus aureus; iMDR, multidrug resistance; jBSI, bloodstream infections caused by multidrug-resistant (MDR) organisms; kLoS, length of stay; lSSI, surgical site infections; mDOT, day of therapy.