Journal article
Effect of antibiotic stewardship programmes on Clostridium difficile incidence: a systematic review and meta-analysis
The Journal of antimicrobial chemotherapy, Vol.69(7), pp.1748-1754
07/2014
DOI: 10.1093/jac/dku046
PMID: 24633207
Abstract
Despite vigorous infection control measures, Clostridium difficile continues to cause significant disease burden. Antibiotic stewardship programmes (ASPs) may prevent C. difficile infections by limiting exposure to certain antibiotics. Our objective was to perform a meta-analysis of published studies to assess the effect of ASPs on the risk of C. difficile infection in hospitalized adult patients. Searches of PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature and two Cochrane databases were conducted to find all published studies on interventions related to antibiotic stewardship and C. difficile. Two investigators independently assessed study eligibility and extracted data. Risk of bias was assessed using the Downs and Black tool. Risk ratios were pooled using random effects models. Heterogeneity was evaluated using the I(2) statistic. The final search yielded 891 articles; 78 full articles were reviewed and 16 articles were identified for inclusion. Included articles used quasi-experimental (interrupted time series or before-after) or observational (case-control) study designs. When the results of all studies were pooled in a random effects model, a significant protective effect (pooled risk ratio 0.48; 95% CI: 0.38, 0.62) was observed between ASPs and C. difficile incidence. When stratified by intervention type, a significant effect was found for restrictive ASPs (complete removal of drug or prior approval requirement). Furthermore, ASPs were particularly effective in geriatric settings. Restrictive ASPs can be used to reduce the risk of C. difficile infection.
Details
- Title: Subtitle
- Effect of antibiotic stewardship programmes on Clostridium difficile incidence: a systematic review and meta-analysis
- Creators
- Leah M Feazel - Carver College of Medicine, University of Iowa, Iowa City, IA, USAAshish Malhotra - Carver College of Medicine, University of Iowa, Iowa City, IA, USA The Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USAEli N Perencevich - Carver College of Medicine, University of Iowa, Iowa City, IA, USA The Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USAPeter Kaboli - Carver College of Medicine, University of Iowa, Iowa City, IA, USA The Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USADaniel J Diekema - Carver College of Medicine, University of Iowa, Iowa City, IA, USAMarin L Schweizer - Carver College of Medicine, University of Iowa, Iowa City, IA, USA The Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA marin-schweizer@uiowa.edu
- Resource Type
- Journal article
- Publication Details
- The Journal of antimicrobial chemotherapy, Vol.69(7), pp.1748-1754
- DOI
- 10.1093/jac/dku046
- PMID
- 24633207
- NLM abbreviation
- J Antimicrob Chemother
- ISSN
- 0305-7453
- eISSN
- 1460-2091
- Publisher
- England
- Language
- English
- Date published
- 07/2014
- Academic Unit
- Infectious Diseases; Epidemiology; Pathology; Internal Medicine
- Record Identifier
- 9983779290502771
Metrics
32 Record Views