Antibiotic Stewardship Cuts Inpatient Infections with Resistant Bacteria

June 30, 2017

By Will Boggs MD

NEW YORK (Reuters Health) - Hospital antibiotic stewardship programs reduce the incidence of inpatient infection and colonization with antibiotic-resistant bacteria and Clostridium difficile, according to a systematic review and meta-analysis.

"The most interesting finding from the study is the increase in benefits if the stewardship programs are implemented alongside programs targeting improvements in infection control procedures and measures, particularly hand hygiene,” said Dr. Evelina Tacconelli from Tuebingen University Hospital in Germany.

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“I would not say that the results were surprising, but definitively to see the evidence confirming what every clinician trying to fight the spread of resistance in daily life knew, was priceless,” she told Reuters Health by email. “We hope these results will push forward the political discussion to provide funding co-prioritizing antibiotic stewardship and infection control in the healthcare settings.”

Antibiotic stewardship programs have been shown to reduce hospital costs and antibiotic use, but it has remained unclear whether they affect the incidence of antibiotic-resistant bacteria.

To investigate, Dr. Tacconelli and colleagues conducted a systematic review, identifying 76 articles, 32 of which were included in their meta-analysis.

Audits comprised the most frequent antibiotic-stewardship interventions (59%), followed by implementation of restrictive policies (47%). In 31% of studies, antibiotic stewardship programs were combined with infection control measures.

Implementation of antibiotic stewardship was associated with a 51% reduction in the incidence of multidrug-resistant Gram-negative bacteria, a 48% reduction in extended-spectrum beta-lactamase-producing Gram-negative bacteria, a 37% reduction in methicillin-resistant Staphylococcus aureus (MRSA), and a 32% reduction in C. difficile infections in hospital inpatients. These drops were all statistically significant.

Antibiotic stewardship interventions reduced these infections significantly in hematology-oncology departments (59% reduction), intensive care units (23%) and medical departments (22%), the researchers report in The Lancet Infectious Diseases, online June 16.

Antibiotic-stewardship programs combined with infection-control measures had a greater effect on reduction of antibiotic resistance (31%) than did implementation of antibiotic-stewardship programs alone (19%), especially when they were combined with hand hygiene (66% vs. 17% reductions without hand hygiene interventions).

Other effective components included antibiotic cycling, audits and feedback, and antibiotic restriction.