Impact of Antimicrobial Stewardship Programs on Antibiotic Prescribing Among Dialysis Patients: A Systematic Review
Author(s)
USMAN ABUBAKAR, PhD1, Walid Kouidri, Student2, Ahmed Habibullah, Student2, Tarek Issa, Student2, Fadel Alhammoud, Student2.
1ASSISTANT PROFESSOR, Qatar University College of Pharmacy, DOHA, Qatar, 2Qatar University College of Pharmacy, DOHA, Qatar.
1ASSISTANT PROFESSOR, Qatar University College of Pharmacy, DOHA, Qatar, 2Qatar University College of Pharmacy, DOHA, Qatar.
OBJECTIVES: To evaluate the impact of antimicrobial stewardship (AMS) programs on antibiotic prescribing and clinical outcomes among dialysis patients.
METHODS: Electronic search was conducted using PubMed and Scopus with supplementary search through Google Scholar to identify published studies in the English language. Primary studies that investigated the impact of AMS on antibiotic prescribing and clinical outcomes among dialysis patients from the inception of the databases to January 2025 were considered for inclusion. Two independent reviewers screened, selected and extracted the data from the included studies, and the data was synthesized qualitatively.
RESULTS: Electronic database searches identified 2036 articles, out of which five articles describing four eligible studies were included (two articles reported different outcomes for the same study). The studies were conducted in the United States, China, Singapore, and the Republic of Korea. Three studies were conducted in inpatient settings, while the other study included outpatient hemodialysis population. All the included studies implemented multiple AMS interventions with prospective audit with feedback (n = 3), educational intervention (n = 2), and pharmacists’ participation in ward rounds (n = 1) reported. Two studies reported a reduction in the rate of inappropriate antimicrobial dosing after the intervention with reductions ranging from 0.15% - 30.3%. Another study revealed that dose adjustment (17.2%) was the second most accepted AMS intervention by prescribers. A significant 6% monthly reduction in antimicrobial doses/100 patient months was reported in one study. The impact of AMS programs on clinical outcomes varied between the studies with some reporting no significant changes in mortality, length of stay, readmission rate, and infection/colonization with multidrug resistant organisms.
CONCLUSIONS: Limited evidence indicates that AMS interventions are effective in improving antibiotic dosing among dialysis patients, and reducing antibiotic use. The impact of AMS on clinical, economic and microbial outcomes require further investigation.
METHODS: Electronic search was conducted using PubMed and Scopus with supplementary search through Google Scholar to identify published studies in the English language. Primary studies that investigated the impact of AMS on antibiotic prescribing and clinical outcomes among dialysis patients from the inception of the databases to January 2025 were considered for inclusion. Two independent reviewers screened, selected and extracted the data from the included studies, and the data was synthesized qualitatively.
RESULTS: Electronic database searches identified 2036 articles, out of which five articles describing four eligible studies were included (two articles reported different outcomes for the same study). The studies were conducted in the United States, China, Singapore, and the Republic of Korea. Three studies were conducted in inpatient settings, while the other study included outpatient hemodialysis population. All the included studies implemented multiple AMS interventions with prospective audit with feedback (n = 3), educational intervention (n = 2), and pharmacists’ participation in ward rounds (n = 1) reported. Two studies reported a reduction in the rate of inappropriate antimicrobial dosing after the intervention with reductions ranging from 0.15% - 30.3%. Another study revealed that dose adjustment (17.2%) was the second most accepted AMS intervention by prescribers. A significant 6% monthly reduction in antimicrobial doses/100 patient months was reported in one study. The impact of AMS programs on clinical outcomes varied between the studies with some reporting no significant changes in mortality, length of stay, readmission rate, and infection/colonization with multidrug resistant organisms.
CONCLUSIONS: Limited evidence indicates that AMS interventions are effective in improving antibiotic dosing among dialysis patients, and reducing antibiotic use. The impact of AMS on clinical, economic and microbial outcomes require further investigation.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO135
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment, Clinician Reported Outcomes
Disease
Infectious Disease (non-vaccine), Urinary/Kidney Disorders