Are antimicrobial stewardship programs effective strategies for preventing antibiotic resistance? A systematic review.

BACKGROUND: Antimicrobial stewardship programs (ASPs) have been proposed as a solution for the global burden of antibiotic resistance, despite the lack of evidence on the subject.

OBJECTIVE: To analyze the role of ASPs in reducing bacterial resistance to antibiotics in hospital settings.

DATA SOURCES: A review in PubMed, Scopus, LILACS, and SciELO databases was performed. The period analyzed was January 1, 2012-January 4, 2017.

ELIGIBILITY CRITERIA: Studies that related ASPs to bacterial resistance.

DATA EXTRACTION: All studies that did not focus on ASPs were removed. Antifungal and antiviral programs were excluded.

RESULTS: Only 8 studies had quasi-experimental designs, and none were controlled trials. ASP strategies and microorganism-antibiotic pairs evaluated varied widely. Seven studies were classified as presenting clearly positive results, 3 had limited positive results, 7 had doubtful results, 4 had negative results, and 5 had noninterpretable results. The implementation of new infection control practices occurred in 7 studies.

LIMITATIONS: There are yet few studies on this matter, and most of them have inadequate study designs. Great heterogeneity between study features was detrimental to drawing evidence-based conclusions.

CONCLUSIONS: There is no solid evidence that ASPs are effective in reducing antibiotic resistance in hospital settings. We uphold the need for more studies with appropriate study designs, standardized ASP interventions targeting common microorganism-antibiotic pairs, and avoiding simultaneous implementation of infection control practices.