Affiliation:
1. College of Pharmacy, Gulf medical university, Ajman, United Arab Emirates
2. Response plus medical, Abu Dhabi, United Arab Emirates
3. Rashid hospital, DHA, Dubai, United Arab Emirates
Abstract
Abstract
Purpose
This meta-analysis aims to find out the impact of pharmacists on clinical outcomes of antimicrobial stewardship (AMS).
Method
Articles were searched and analyzed based on quality assessed through the JSM quality assessment tool to filter articles with a low level of bias. Two thousand three hundred sixty articles were reviewed for initial screening and 28 articles were included for critical analysis. Statistical analysis used to risk ratio (RR) and standard mean differences calculated using Review manager 5.4. Confidence intervals (CI 95%) were calculated using the fixed-effect model. The I2 statistic assessed heterogeneity. A random-effect model performed in the case of statistical heterogeneity, subgroup and sensitivity analyses. The primary outcome is mortality and inappropriateness, whereas the secondary outcome is cost, readmission, length of stay, consumption and duration of therapy.
Result
A detailed review and analysis of 28 AMSs programs led by pharmacists showed low inappropriateness with pharmacist versus without pharmacist RR = 0.36 with 95% CI of (0.32 to 0.39) and mortality RR is 0.68 with 95% CI of 0.59 to 0.79. Secondary outcomes such as consumption, length of stay, duration of therapy and cost are standard mean difference of −1.61 with 95% CI (−1.72 to −1.50), −0.58 with 95% CI (−0.62 to −0.53), −0.95 with 95% CI (−1.01 to −0.89) and −0.99 with 95% CI (−1.12 to −0.86), respectively, whereas for 30 days readmission is RR = 0.81 with 95% CI (0.70 to 0.93).
Conclusion
AMS with pharmacist effectively reduces mortality, inappropriateness, cost, length of stay, duration of treatment, consumption of antimicrobials and the return rate to hospital. So it is suggested pharmacists should lead or play a vital role in antimicrobial stewardship programs to get better outcomes.
Publisher
Oxford University Press (OUP)
Subject
Pharmacology, Toxicology and Pharmaceutics (miscellaneous),Economics, Econometrics and Finance (miscellaneous)
Reference45 articles.
1. Executive summary: implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America;Barlam,2016
2. Overview of strategies for overcoming the challenge of antimicrobial resistance;Davey,2010
3. What is antimicrobial stewardship?;Dyar,2017
4. Interventions to improve antibiotic prescribing practices for hospital inpatients;Davey,2017
Cited by
6 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献