Can digital interventions enhance antimicrobial stewardship?

Bethany A Van Dort, Jonathan Penm, Angus Ritchie, Melissa T Bayları

Background: Antimicrobial stewardship (AMS) programs are multifaceted hospital-wide collections of strategies aimed to optimise antimicrobial use. With the increased use of health information technology in hospitals, AMS processes are being streamlined. There have been a number of published systematic reviews on digital interventions supporting AMS, but no attempt to consolidate all findings.

Aims: To provide a systematic overview and synthesis of evidence on the effectiveness of digital interventions to improve antimicrobial prescribing and monitoring in hospitals. In particular, we focused on the digital interventions evaluated, outcome measures used, and the effectiveness of the digital interventions in improving antimicrobial use.

Methods: A systematic review was conducted. Papers were eligible if they were systematic reviews that examined the effectiveness of digital health interventions related to antimicrobial prescribing and monitoring, in an inpatient hospital setting. Databases; Medline, Embase, Scopus, CINAHL and the Cochrane Database of Systematic Reviews were searched from 2010 onwards.

Results: Seven systematic reviews were included for data extraction. Five reviews were of moderate quality and two low-quality. A large number of different types of digital interventions were evaluated, but most constituted some type of computerised decision support. There was large variability in outcome measures used. Six reviews reported that digital interventions reduced antimicrobial use and improved antimicrobial appropriateness. The impact of digital interventions on clinical outcomes was inconsistent.

Conclusions: The results of this review indicate that digital interventions, regardless of type, reduce antimicrobial use and improve antimicrobial appropriateness in hospitals. We recommend hospitals consider implementing one or more digital interventions to facilitate AMS programs.