Mariabe Quinco, University Of Immaculate Conception, Davao City, Phillippines
ABSTRACT
World Health Organization (WHO) stated that one of the ten threats to global health in the year 2019 is antimicrobial resistance (AMR) or antibiotic resistance. The AMR happens when microorganisms, such as bacteria and fungi, develop the ability to stop an antimicrobial, or multiple antimicrobials, from working against it. Its emergence is creating "superbugs" that make treating basic infections difficult and surgery risky. The purpose of this study was to summarize multiple interventional studies into a single report to validate if these interventions would establish a statistically significant difference in antibiotic resistance reduction between patients managed by a Physicians – Pharmacists Team intervention in antimicrobial stewardship programs and those regular patients who were given only the usual medical treatment. The researcher performed a systematic search of Biomed Central, NCBI, Proquest, Elsevier, Google Scholar, Cochrane electronic databases, and EBSCOhost(UIC-Lrsc) from 2000- 2019. Studies were included if they are RCTs or have the quasi-experimental design. Initial studies reviewed were 351, and only 12 studies met the inclusion criteria and selected for systematic review and meta-analysis. The researcher identified five intervention types: Audit and Feedback (6), Point of Care (3), Automatic Stop Order (1), ASP intervention on SAB therapy (1), and Post Prescription Review and Authorization done by a trained pharmacist (1). Physicians – Pharmacists Team interventions were associated with reductions in DDD of surgical antibiotic prophylaxis in antibiotic utilization (control: 16.6 vs. exptl: 12.8, p=0.000), total number of antibiotic days per patient (control: 7.6 vs. exptl: 6.6, p=0.006), bacteremia > 7 days (control: 4 days vs. exptl: 3 days, p=0.024), length of stay (control: 7.2 vs. exptl: 6.5, p=0.004), infection-related mortality no. (control: 16 vs. exptl: 8, p=0.047) , overall time to first antibiotic (control: 9:09 vs. exptl: 1:23, p<0.001), antibiotic consumption (control 33% vs. exptl: 3% , p=0.003), median duration of IV antimicrobial treatment (control: 71.7 hours vs. exptl: 55.5 hours, p=0.017), length of antimicrobial therapy (control: 11 days vs. exptl: 10 days, p=0.000), length of IV therapy (control: 10 days vs. exptl: 8 days, p>0.001), total # of DDD of the targeted antibiotics (control: 10 vs. exptl: 8, p=0.040) and total # of days receiving the targeted antibiotics per patient (control: 6 vs. exptl: 4, p=0.002). In conclusion, the results emphasized that the Physicians – Pharmacists Team interventions in antimicrobial stewardship such as Audit and Feedback, Point of Care, Automatic Stop Order, and ASP intervention on SAB therapy are more effective than the conventional methods. Thus, these interventions in antimicrobial stewardship will significantly reduce, lessen, slow down, or prevent the emergence of antimicrobial resistance. Furthermore, among the various interventions, the prospective audit and feedback strategy will have a greater chance to be widely applied because of its clear advantages.Keywords: Pharmacy, Physicians - Pharmacists Team intervention, antimicrobial stewardship (AMS), antimicrobial stewardship program, antimicrobial resistance, systematic review, meta-analysis, Philippines