Implementation of antimicrobial stewardship interventions on prescribing rates for urinary tract infections in residential aged care facilities: a systematic review and meta-analysis
Abstract
Background and rationale: Current research identifies a large proportion of urinary antimicrobial prescribing in aged care as being non-concordant, however, the efficacy of interventions targeted at reducing these prescriptions in aged care remains unclear. This review summarises effective interventions targeting non-concordant urinary antimicrobial prescriptions in aged care.
Methods: This review follows PRISMA reporting guidelines and includes studies published up to June 2024. The search aimed to capture interventional studies and included studies that examined urinary tract infections in the aged care setting. All hospital-based studies and non-interventional studies were excluded. The search was conducted in 6 databases: PubMed, Scopus, Embase, PsychInfo, CINAHL Ultimate, and AgeLine. All studies were assessed against the ROBINS-I risk of bias tool. Meta-analyses for effects on urinary prescribing and hospitalisations were conducted on eligible studies and pooled risk ratios were calculated using DerSimonian and Laird random effects modelling.
Results: Twenty studies were included and interventions from four eligible randomised controlled trials were selected for the meta-analysis. The meta-analyses indicate that educational interventions coupled with routine audits were effective at reducing urinary prescribing (RR = 0.64, 95% CI = 0.49 - 0.83) and does not increase the risk of hospitalisations (RR = 1.02, 95% CI = 0.70 - 1.49). The review found that while effective…
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