A systematic review investigating the use of microbiology outcome measures in randomised controlled trials evaluating antimicrobial stewardship interventions over the past 10 years

Problem

AntiMicrobial Resistance (AMR) is one of the most serious global public health threats this century. Antimicrobial stewardship interventions (ASI) are a component of a multi-faceted approach to improve appropriate prescribing of antimicrobials, optimise clinical outcomes for the patient, reduce adverse effects and emergence of AMR. ASIs are also identified as one of the key actions of the World Health Organization Global Action Plan to contain AMR.

ASIs have proved to be beneficial in numerous health care settings. However, several reviews show that many ASIs focus exclusively on process measures, with lack of evidence for clinical and microbiological impacts of these interventions. This is surprising given that reducing AMR is the ultimate goal of ASIs and AMR can only be measured if the microbiological data is collected.

Approach

A systematic methods review is being conducted to investigate the use of microbiology outcome measures in ASIs and to describe the analytic approaches used to report the microbiological outcome. A systematic review protocol has been written and published on the PROSPERO website. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226585

The search strategy included performing searches on electronic databases (PubMed & EMBASE) of published articles using both MeSH headings and key words between 1st February 2011 and 1st February 2021.

Studies considered for inclusion were antimicrobial stewardship trials that involved human subjects at any age in both primary care and secondary care settings. Only randomised controlled trials (RCT) evaluating at least one antimicrobial stewardship intervention were included. Systematic reviews, meta-analyses, non-RCTs, case reports, protocols, non-English language, studies concerning animals and non-humans; or focused mainly on human immunodeficiency virus were excluded.

Findings

Currently at data extraction stage. Information such as study title, year of publication, location of the study, study setting, sample size, whether microbiological outcome was collected, type of outcomes collected, number of participants with the outcome and included in the analysis, and analytical approach/es will be extracted from each included paper. Analysis will be finished at the end of April 2021. A summary of the findings will be presented at this conference.

Consequences

This will be the first systematic review evaluating the use of microbiological outcomes in RCTs of ASIs. Appraising if microbiological outcomes have been collected and how these data have been analysed is an important step towards understanding whether efficiencies in trial conduct can be gained by maximising the richness often contained within microbiological datasets. This work will pave the way for further investigations into more alternative analytical approaches which focuses on maximises the information gained from high-dimensional data such as these.