The effect of digital antimicrobial stewardship programmes on antimicrobial usage, length of stay, mortality and cost

Introduction: Antimicrobial stewardship aims to slow the emergence of antimicrobial resistance. We conducted a systematic review on the use of digital antimicrobial stewardship programmes (ASP) on antimicrobial usage, cost, length of stay (LoS) and mortality. Methods: We identified, quality appraised using the Newcastle-Ottawa scale, and descriptively and narratively synthesised data on primary research articles that implemented an ASP(s) for adult inpatients for at least six months, and reported antimicrobial usage as defined daily dose (DDD) per 1000 patient days and at least one of: LoS, mortality or cost. Our review was registered with PROSPERO: CRD42020154124 and adhered to the PRISMA guideline. Results: Our searches retrieved 3,997 titles, from which 13 studies were included. The risk of bias assessment resulted in 10 studies receiving a rating of 7 stars or over. A range of ASPs were implemented using computerised decision support (CDS) systems, including those that combined audit and feedback, guidelines and approval, computerised approval processing, computerised recommendations and surveillance. All studies found a decrease in antimicrobial usage (DDD range, −8.42% to −61.29%). All six studies that considered costs also showed a decrease (range, −8.12% to −69.19%). Six studies reported a decrease in mortality and one showed no change. Discussion: The digital ASP programmes investigated appeared to have a positive impact on antimicrobial usage and clinical outcomes. Our review found that ASPs that utilised an audit and feedback approach showed a promising and consistent reduction in DDD.