Modelling and meta-analyses of antimicrobial stewardship efficacy. More summaries from #ECCMID2016



by Guillaume Béraud

One of the most interesting sessions I had the opportunity to assist was “Modelling and meta-analyses of antimicrobial stewardship efficacy” which exposed some results involving mathematical modelling on the fields of antimicrobial resistance

  • Esther Van Kleef from London, UK, showed how informed prescribing could impact the emergence of resistant Klebsiella pneumonia. A mathematical model compared the use of Rapid Diagnostic Testing (RDT) to empiric prescribing and cycling. In a low transmission setting, the RDT would effectively result in a small decrease in the emergence of resistant K. pneumonia but still much more importantly than cycling or empiric prescribing. The impact would be more important with high levels of cross-transmission.


  • Evelina Tacconelli from Tubingen, Germany, included 21 studies in a meta-analysis to assess the impact of antimicrobial stewardship programs (ASP) on antibiotic resistant infections and C. difficile rates. The results confirmed that ASP are highly effective at reducing infections and colonisation rates, although with important variations according to the pathogen.


  • Esther Van Kleef modelled the impact of restricting high-risk antibiotics on clostridium difficile incidence and confirmed its benefice, however without taking into account the potential need to treat gram negative infections.


  • Gwenan Knight used a mathematical model to determine the relative importance of antimicrobial prescribing in the community and in the hospital on the emergence of antimicrobial resistance. She showed that the majority of antibiotic resistance may occur in the community rather than in the hospital.


  • Emelie Cecile Schuts presented a systematic review aiming at assessing the most efficient antimicrobial stewardship objectives in long term care facilities. Nine objectives out of 14 were significantly efficient, namely empirical therapy according to guideline, de-escalation, IV to oral switch, therapeutic drug monitoring, using a list of restricted antibiotics and bedside consultation (notably in case of S. aureus infection).

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