Although restriction of carbapenems or third-generation cephalosporins did not decrease the prevalence of antibiotic resistance among intestinal, non-fermented, or Gram-positive bacteria, it was found that reducing the use of fluoroquinolones and piperacillin tazobactam reduced resistance in non-fermented adults in the hospital, according to the results. Systematic review and meta-analysis published in Open the infectious disease forum. The study authors suggest that a multifactorial intervention, rather than a single intervention of restricted antibiotic use, may be a more effective tool to combat antimicrobial resistance in hospitals.
This meta-analysis included 15 international monitoring studies that reported the number of isolates tested for enteric, non-fermented, or Gram-positive bacteria in a hospital or intensive care unit. The analysis focused on 3 classes of restrictive antibiotics (carbapenems, fluoroquinolones, and third-generation cephalosporins) and two non-restricted antibiotics (piperacillin-tazobactam and first and second-generation cephalosporins).
Most studies reported prevalence of resistance in the enteric and non-fermented ones to both restricted and unrestricted antibiotics. In general, there was a low quality of evidence for the studies, and most showed a high degree of heterogeneity for most groups of antibiotics and pathogens, with the following exceptions: piperacillin-tazobactam / non-fermented, piperacillin-tazobactam / enteric bacteria, and fluoroquinolones / enteric (I2= 0% for everyone).
When comparing the pooled odds of having resistance during the post-intervention versus the pre-intervention period, a 23% and 19% reduction in non-fermentation resistance was observed after restriction of the use of fluoroquinolones (odds ratio [OR], 0.77; 95% CI, 0.62-0.97) and piperacillin-tazobactam (OR, 0.81; 95% CI, 0.72-0.92), respectively.
Sensitivity analysis with the exception of studies containing fewer than 50 bacteria yielded similar results. Additionally, “There was no evidence of publication bias for any of the antibiotic combinations and pathogens,” the study authors note.
Limitations of this study were an exclusion of the gray literature and a focus on the 3 limited classes of antibiotics. Studies varied in publication date (1985 to 2020) and antibiotic prescribing practices, and resistance rates changed dramatically over that period.
The authors state: “… antibiotic restriction policies as a single intervention may not be an effective tool for achieving a reduction in the prevalence of resistance in hospitalized adults.” The authors conclude that there is a need for high-quality studies “… to explore alternative interventions that could give way to reducing the prevalence of antimicrobial resistance.”
Schuts EC, Boyd A, Muller AE, Mouton JW, Prins JM. The effect of antibiotic restriction programs on the prevalence of antimicrobial resistance: a systematic review and meta-analysis. Open forum dis infect. Posted online February 13, 2021. doi: 10.1093 / ofid / ofab070