Hospital antimicrobial stewardship program implementation in the Gulf Cooperation Council States: a systematic review of evidence of implementation.

Hashad, N.; Tonna, A.; Perumal, D.; Stewart, D.

Abstract

Background and Purpose: Antimicrobial resistance (AMR) has led to the development of initiatives aimed at optimizing antimicrobial use. Co-ordinated interventions for promoting and monitoring safe and effective use of antimicrobials are termed antimicrobial stewardship programs (ASP). While there are several systematic reviews on aspects of ASP, none have focused on the processes and outcomes of implementation in the Gulf Cooperation Council (GCC) States. The aim was to critically appraise, synthesize and present the available evidence on ASP implementation in the GCC States in relation to the interventions, reported outcomes and facilitators and barriers to implementation. Methodology: A systematic review protocol was developed based on PRISMA-P guidelines and registered with PROSPERO (International Prospective Register of Systematic Reviews). Electronic databases (MEDLINE, CINAHL, International Pharmaceutical Abstracts, Cochrane database and Web of Science) were searched using pre-specified terms for peer-reviewed publications in English from 2010 onward. Quality assessment, data extraction and synthesis were independently performed by two reviewers. ASP interventions were compared to the Centre of Disease Control and Prevention (CDC) checklist, a systematic assessment of key ASP interventions. Results and Discussions: ASP interventions implementation in line with CDC checklist were weak, with the majority of studies reporting only one third of the expected CDC criteria. The most commonly reported outcomes were antibiotic consumption, with very little reporting of any microbiological, clinical and economic outcomes. Key facilitators were physician and organisation support. Barriers reported included the lack of dedicated staff and lack of sufficient funding for implementation. Conclusions: There is a lack of robust studies of ASP implementation in the GCC States. Such studies should focus on CDC criteria in developing the ASP intervention and report valid and reliable outcomes including microbiological, clinical and economic outcomes. There is also a need for qualitative research to focus on facilitators, barriers and solutions to implementation.

Citation

HASHAD, N., TONNA., A., PERUMAL, D. and STEWART, D. 2019. Hospital antimicrobial stewardship program implementation in the Gulf Cooperation Council States: a systematic review of evidence of implementation. Presented at 4th Gulf congress of clinical microbiology and infectious diseases (GCCMID 2019), co-located with the 31st International congress of antimicrobial chemotherapy (ICC 2019) (ICC-GCCMID 2019), 6-9 November 2019, Dubai, UAE.

• Presentation Conference Type: Poster
• Conference Name: 4th Gulf congress of clinical microbiology and infectious diseases (GCCMID 2019), co-located with the 31st International congress of antimicrobial chemotherapy (ICC 2019) (ICC-GCCMID 2019)
• Start Date: Nov 6, 2019
• End Date: Nov 9, 2019
• Deposit Date: May 7, 2020
• Publicly Available Date: May 7, 2020
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Keywords: Public Health, Environmental and Occupational Health; Infectious Diseases; General Medicine
• Public URL: https://rgu-repository.worktribe.com/output/845656