Identification of outcomes reported for hospital antimicrobial stewardship interventions using a systematic review of reviews.

Shazia Yousuf* (Corresponding Author), Magdalena Rzewuska, Eilidh Duncan, Craig Ramsay

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: Randomised trials of hospital antimicrobial stewardship (AMS) interventions aimed to optimise antimicrobial use contribute less to the evidence base due to heterogeneity in outcome selection and reporting. Developing a core outcome set (COS) for these interventions can be a way to address this problem. The first step in developing a COS is to identify and map all outcomes.
Objective: To identify outcomes reported in systematic reviews of hospital AMS
interventions.
Methods: Cochrane database of Systematic reviews, MEDLINE, and EMBASE were searched for systematic reviews published up until August 2019 on interventions relevant to reducing unnecessary antimicrobial use for inpatient populations in secondary care hospitals. The methodological quality of included reviews was assessed using AMSTAR-2. Extracted outcomes were analysed using deductive and inductive thematic analysis. A list of overarching (unique) outcomes reflects the outcomes identified within the systematic reviews.
Results: Forty-one systematic reviews were included. Thirty-three (81%) systematic reviews were critically low or low quality. A long list of 1,739 verbatim outcomes was identified and categorised under five core areas of COMET taxonomy: 'resources use' (45%), 'physiological/clinical' (27%), 'life impact' (16%), 'death' (8%), 'adverse events' (4%). A total of 421 conceptually different outcomes were identified and grouped into 196 overarching outcomes.
Conclusion: There is significant heterogeneity in outcomes reported for hospital AMS interventions. Reported outcomes do not cover all domains of COMET framework and may miss outcomes relevant to patients (e.g., emotional, social functioning, etc.). The included systematic reviews lacked methodological rigour, which warrants further improvements
Original languageEnglish
Article numberdlac127
Number of pages9
JournalJAC-Antimicrobial Resistance
Volume5
Issue number1
Early online date2 Jan 2023
DOIs
Publication statusPublished - Jan 2023

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