The Journal of hospital infection · 2026
Antimicrobial stewardship interventions in adults with hospital-acquired pneumonia: a systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ablakimova N, Rachina S, Strelkova D, Suvorov A, Smagulova G
Аннотация
BACKGROUND: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) represent the most severe healthcare-associated infections (HAIs), characterized by high morbidity, mortality and antimicrobial resistance rates.
AIM: The aim of this study was to systematically assess the impact of antimicrobial stewardship and diagnostic interventions on clinical, microbiological and process outcomes in adult patients with HAP/VAP.
METHODS: A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (International Prospective Register of Systematic Reviews registration number: CRD42023492494). PubMed, Scopus and Web of Science databases were searched for studies published from 2000 to May 2025. Eligible designs included randomized trials, quasi-experimental and before-and-after studies involving adults with HAP or VAP. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were estimated using random-effect models in R (meta package).
FINDINGS: Nineteen studies were included, of which 11 were meta-analysed. Antimicrobial stewardship programme (ASP) interventions significantly reduced the duration of antibiotic therapy (SMD = -1.02; 95% confidence interval [CI]: -1.76 to -0.28; P = 0.007). A significant improvement was also observed for protocol adherence (OR = 5.91; 95% CI: 1.26-27.67; P = 0.024). No statistically significant differences were found for hospital mortality (OR = 0.73; 95% CI: 0.51-1.05; P = 0.088), 30-day in-hospital mortality (OR = 1.13; 95% CI: 0.73-1.76; P = 0.58), length of intensive care unit (ICU) stay or ventilator-free days. Heterogeneity was high across designs.
CONCLUSION: Stewardship interventions for HAP/VAP safely shorten antibiotic duration and improve adherence to clinical protocols without compromising patient safety. To achieve more meaningful clinical impact, future ASP models should integrate diagnostics, pharmacokinetic/pharmacodynamic-guided dosing and ventilator-care bundles within multi-disciplinary ICU frameworks.
AIM: The aim of this study was to systematically assess the impact of antimicrobial stewardship and diagnostic interventions on clinical, microbiological and process outcomes in adult patients with HAP/VAP.
METHODS: A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (International Prospective Register of Systematic Reviews registration number: CRD42023492494). PubMed, Scopus and Web of Science databases were searched for studies published from 2000 to May 2025. Eligible designs included randomized trials, quasi-experimental and before-and-after studies involving adults with HAP or VAP. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were estimated using random-effect models in R (meta package).
FINDINGS: Nineteen studies were included, of which 11 were meta-analysed. Antimicrobial stewardship programme (ASP) interventions significantly reduced the duration of antibiotic therapy (SMD = -1.02; 95% confidence interval [CI]: -1.76 to -0.28; P = 0.007). A significant improvement was also observed for protocol adherence (OR = 5.91; 95% CI: 1.26-27.67; P = 0.024). No statistically significant differences were found for hospital mortality (OR = 0.73; 95% CI: 0.51-1.05; P = 0.088), 30-day in-hospital mortality (OR = 1.13; 95% CI: 0.73-1.76; P = 0.58), length of intensive care unit (ICU) stay or ventilator-free days. Heterogeneity was high across designs.
CONCLUSION: Stewardship interventions for HAP/VAP safely shorten antibiotic duration and improve adherence to clinical protocols without compromising patient safety. To achieve more meaningful clinical impact, future ASP models should integrate diagnostics, pharmacokinetic/pharmacodynamic-guided dosing and ventilator-care bundles within multi-disciplinary ICU frameworks.