ANTIMICROBIAL RESISTANCE AND ASSOCIATED INTERVENTIONS IN LOW- AND MIDDLE-INCOME COUNTRY INTENSIVE CARE UNITS: SCOPING REVIEW
CCCF ePoster library. Geagea A. Oct 3, 2017; 198203; 75
Dr. Anna Geagea
Dr. Anna Geagea
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Abstract
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ANTIMICROBIAL RESISTANCE AND ASSOCIATED INTERVENTION IN LOW- AND MIDDLE-INCOME COUNTRY INTENSIVE CARE UNITS: SCOPING REVIEW.

AN Geagea1, RB Reka2, M Siarkowski3, L Espinosa-Perez1, AP Ayala2, NK Adhikari4

Interdepartmental Division of Critical Care Medicine, University of Toronto1

Gerstein Science Information Centre, University of Toronto2

Cumming School of Medicine, University of Calgary3

Department of Critical Care Medicine, Sunnybrook Health Sciences Centre4

 


Introduction
Antimicrobial resistance (AMR) is a growing concern worldwide and is increasingly recognized in low- and middle-income countries (LMICs), particularly in intensive care units (ICUs). Several interventions may reduce the burden of AMR.
 
Objective
The objective of this study was to map the breadth of interventions and their impact on AMR in LMIC ICUs and identify gaps in the literature.
 
Methods
We conducted a scoping review according to standard methods, and searched Medline, Embase, LILACs, Africa-Wide and PAIS International databases (up to November 2016) and OpenGrey, IDEAS, UCL IRIS, Grey Literature Report, African Index Medicus, African Journals Online, Med Carib, IMSEAR, WPRIM, WHOLIS grey literature sources as well as the WHO, MSF and African Development Bank websites (up to April-May 2017). Two reviewers independently and in duplicate screened citations and selected studies that evaluated interventions to reduce AMR in LMIC ICUs and that included a historical or contemporaneous control group.
 
Results
We retrieved 383 articles for full text screen from 3869 de-duplicated citations from conventional databases and 17 articles from 2477 citations in grey literature sources. Out of 400 articles selected for full text review, 5 were not accessible. Ninety-four studies published between 1991 and 2016 met our inclusion criteria, of which 3 are pending translation. Non-English languages among included articles (n=10) are French, Spanish, Chinese and Turkish.
Most studies were cohort studies with a historical control group (n=50, 55%); the remainder were cohort studies with a contemporaneous control group (n=5, 6%), randomized controlled trials (n=4, 4%) and cross-over studies (n=1, 1%). We also found 31 cohort studies (34%) of outbreaks; these typically had a very short baseline control period. Studies were conducted in adult ICUs (n=29, 32%), neonatal ICUs (n=18, 20%), pediatric ICUs (n=5, 5%), combined ICUs (n=13, 14%); 26 studies (29%) did not report this information.
Of 60 non-outbreak studies, the most common interventions evaluated were hand hygiene (n=28, 47%) and infection control practices (n=27, 45%), followed by antimicrobial-related interventions (n=20, 33%), patient or healthcare worker decolonization (n=17, 28%), environmental decontamination or ICU relocation (n=9, 15%), limitation of stress ulcer prophylaxis (n=3, 5%), laboratory interventions (n=1, 2%) and other interventions (n=2, 3%). Antimicrobial-related interventions included stewardship (n=7, 12% of total), restriction (n=8, 13%) and cycling (n=1, 2%). Interventions were implemented through education (n=35, 58%); policies, guidelines, or protocols (n=19, 32%); and audit and feedback (n=15, 25%).
Studies reported on microbiological-related outcomes (for example, resistance patterns; n=50, 83%), patient-related outcomes (for example, new healthcare-associated infections, n=45, 75%; mortality, n=22, 37%; ICU length of stay, n=22, 37%), process of care outcomes (for example, intervention compliance, n=24, 40%; defined daily dose of antibiotics prescribed, n=22, 37%), and costs (n=10, 17%).
 
Conclusion
We found 91studies of a wide range of AMR interventions in LMIC ICUs, confirming the value of a scoping review to compile and summarize this literature. Current studies are limited by heterogeneity of design, interventions, and measured outcomes. RCTs of feasible, scalable, and generalizable interventions are required to identify optimal approaches.
 

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