Background Antimicrobial resistance (AMR) has led to the development of initiatives aimed at optimising antimicrobial use. Coordinated interventions for promoting and monitoring the safe and effective use of antimicrobials are termed antimicrobial stewardship programmes (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.
Purpose The aim was to critically appraise, synthesise 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.
Material and methods A systematic review protocol was developed based on PRISMA-P guidelines and registered with the 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 onwards. 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 Fifteen quantitative studies were included. Quality assessment indicated that two were ‘good quality’, two ‘poor’ and the remainder ‘fair’. Studies were mostly based in Saudi Arabia (n=10), Qatar (n=3), United Arab Emirates (n=1) and Kuwait (n=1). ASP interventions’ implementation in line with the 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. Only six studies reported facilitators and barriers relating to ASP intervention. Key facilitators were physician and organisation support and education. Barriers reported included the lack of dedicated staff, workload issues and lack of sufficient funding for implementation.
Conclusion 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.
References and/or acknowledgements CDC, 2017. Available from: https://www.cdc.gov/antibiotic-use/healthcare/implementation/checklist.html (accessed 25 Sep 2018.)
No conflict of interest.
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