Background and Importance Antimicrobial resistance (AMR) is a global problem threatening public health, security and economic development. Antimicrobial stewardship (AMS) programmes have been implemented worldwide as they have demonstrated clinical, economical and ecological benefits promoting the adequate use of antibiotics. Pharmacist-led antimicrobial stewardships (AMS) interventions are proposed as key strategies to optimise antibiotic use and reduce adverse events, including the selection of antimicrobial resistance. Systematic reviews are at the highest level of the evidence validity hierarchy and provide insight and support policy-makers in clinical practice and research.
Aim and Objectives To evaluate the quality of the systematic reviews measuring the impact of PHARMACIST-LED AMS interventions.
Material and Methods An umbrella review of the systematic reviews on AMS was conducted following the PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) guideline. Following prospective registration (Prospero CRD42022333928), two reviewers independently searched in PubMed, Scopus, Cochrane Library and Google Scholar, without language or time restrictions until June 2022. We included systematic reviews covering pharmacist-led AMS interventions. Two reviewers independently assessed methodological quality using a modified AMSTAR-2 tool and collated the main findings.
Results From 1004 citations, 20 reviews were eligible for inclusion summarising a total of 648 studies . The overall quality of 15 (75%) reviews was critically low. Four studies (20%) were of low quality and one study was of high quality (5%). The most loss-making domains involve providing a list of excluded studies, measuring the risk of bias (RoB) with an appropriate tool, to explicitly state that the review methods were previously established and taking RoB into account in the interpretation of results. The only high-quality study (5%) reported on the sources of funding for the studies included in the review and provided a list of excluded articles.
Conclusion and Relevance Systematic reviews provide the best level of evidence, but their quality must be assured. The overall quality of the systematic reviews measuring the impact of PHARMACIST-LED AMS interventions is low. There is a need for high level literature covering the participation and implication of pharmacists in AMS. The real impact of AMS is unknown to support policy makers and efficient designs in both clinical practice and research.
Conflict of Interest No conflict of interest
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