Impact of antimicrobial stewardship program on antimicrobial-resistance and prescribing in nursing homes: a systematic review and meta-analysis

The success of the antimicrobial stewardship program (ASP) is more often measured in antimicrobial use in the literature; however, there is limited evidence regarding antimicrobial resistance (AMR). This study aims to systematically review the impact of urinary tract infection-targeted ASP on overall AMR, antimicrobial use, and specific to fluoroquinolone (FQ) use in nursing homes (NHs).This systematic review and meta-analysis included studies published in EMBASE, PubMed, Scopus, Medline, and Cochrane Central Register of Controlled Trials. Two reviewers independently extracted data in standard forms in "Covidence." The outcome was presented in percent change and rate ratio. Meta-analysis was done using DerSimonian and Laird random-effects model with inverse variance weighting.A total of 216 NHs participated in 16 included studies. Most of the ASP was educational, targeted to nurses and physicians. Four studies reported information about uropathogens resistance, 10 FQ-related, 13 antimicrobials prescribed, and 11 urine cultures. ASP had a positive impact on reducing overall and FQ-related AMR. However, fewer studies representation with varying information did not allow us to generalise. ASP performance was impressive in reducing antimicrobial prescribing (pooled rate ratio = 0.69, 95% CI 0.60-0.81, P ≤ 0.001) and urine culture rate (pooled rate ratio = 0.64, 95% CI 0.61-0.67, P ≤ 0.001) in NHs.The findings are encouraging despite the limited studies reported ASP impact on AMR. However, it takes years to see the impact of ASP on AMR. Therefore, future research should allocate a long-term follow-up and at least an outcome related to AMR to generate concrete evidence.