Conceptual framework of antibiotic stewardship programs in reducing ESBL-producing Enterobacteriaceae: a systematic review and meta-analysis

Abstract

Today, the phenomenon of antibiotic resistance has become one of the main concerns of health system around the world. Antimicrobial stewardship programs (ASPs) are considered as the most important strategy in optimizing antibiotic consumption, which in turn reduce the emergence of multidrug/extensively drug-resistant (MDR/XDR) microorganisms, as well as reducing mortality and healthcare costs. However, the effectiveness of APSs in controlling the spread of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae has not been investigated. The pooled odds ratio for the effectiveness of ASPs in reducing ESBL-producing Enterobacteriaceae was 0.82 (95% CI: 0.70–0.98; P value: 0.03); our results showed that in group with implemented ASPs, the prevalence of infection associated with these bacteria had been reduced by 11.8%. Overall, antimicrobial stewardship strategies are significantly effective in reducing ESBL-producing Enterobacteriaceae infections. The present study concluded that a comprehensive stewardship program will certainly reduce the mortality rate, as well as hospitalization stay and treatment costs. In general, our findings strongly support the performance of ASPs in healthcare centers.

Keywords:

• Antibiotic stewardship programs
• ESBL
• Enterobacteriaceae
• Escherichia coli
• Klebsiella pneumonia
• meta-analysis

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics approval and consent to participate

Not applicable (this paper was provided based on researching in global databases).

Consent for publish

Not applicable.

Funding

We have not received any funding for this research.

Acknowledgements

We appreciate from both Mashhad University of Medical Sciences and Jiroft University of Medical Sciences.

Authors' contributions

1. MK1 have contributed to design of the work.

2. HK have contributed to design of the work.

3. KGH have contributed to design of the work.

4. MK2 have drafted the work and substantively revised it.

All authors read and approved the final manuscript.