Evidence map›Paper›PMID 29695883›Full record

SynthesisBulletin of the World Health Organization2018

Antibiotic stewardship interventions in hospitals in low-and middle-income countries: a systematic review.

Christophe Van Dijck, Erika Vlieghe, Janneke Arnoldine Cox

Open access · diamondAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Bulletin of the World Health Organization, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 86 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
86citing papers in PubMed, 6 pooled it
13.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

86 citing papers in PubMed, 6 syntheses or guidelines pooled it, 143 citations in OpenAlex.

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26 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 1 institution in 1 country.

Christophe Van DijckFaculty of Medicine and Health Sciences, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium.
Erika VliegheUnit of Internal Medicine and Infectious Diseases, University Hospital Antwerp, Antwerp, Belgium.
Janneke Arnoldine CoxUnit of Tropical Laboratory Medicine, Institute of Tropical Medicine, Antwerp, Belgium.
Antwerp University Hospital · BE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo review the effectiveness of antibiotic stewardship interventions in hospitals in low- and middle-income countries.

methodsWe searched MEDLINE®, Embase®, Cochrane Central Register of Controlled Trials and regional indexes for studies of interventions to improve appropriate prescribing and use of antibiotics for hospitalized patients in low- and middle-income countries. We included controlled trials, controlled before-and-after studies and interrupted time-series studies published up to December 2017. We report prescribing, clinical and microbiological outcomes using a narrative approach.

findingsWe screened 7342 original titles and abstracts, assessed 241 full-text articles and included 27 studies from 2 low-income and 11 middle-income countries. We found a medium (11 studies) or high risk (13 studies) of bias. Generally, all types of interventions (structural, persuasive and enabling) and intervention bundles were reported to improve prescribing and clinical outcomes. However, the studied interventions and reported outcomes varied widely. The most frequent intervention was procalcitonin-guided antibiotic treatment (8 of 27 studies, all randomized controlled trials). The intervention was associated with a relative risk for patients receiving antibiotics ranging between 0.40 and 0.87.

conclusionThe majority of studies reported a positive effect of hospital antibiotic stewardship interventions. However, we cannot draw general conclusions about the effectiveness of such interventions in low- and middle-income countries because of low study quality, heterogeneity of interventions and outcomes, and under-representation of certain settings. To strengthen the evidence base, action needs to be taken to address these shortcomings.

Indexed as

Antimicrobial StewardshipAnti-Bacterial AgentsBacterial InfectionsChildCross InfectionDrug Resistance, BacterialFemaleHospitalsHumansPractice Patterns, Physicians'PregnancyRandomized Controlled Trials as TopicAnti-Bacterial Agents

Identifiers

PMID29695883
PMCPMC5872012
OpenAlexW2795128489

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.