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Stalteri Mastrangelo R, Hajizadeh A, Piggott T, Loeb M, Wilson M, Lozano LEC, Roldan Y, El-Khechen H, Miroshnychenko A, Thomas P, Schünemann HJ, Nieuwlaat R. In-Hospital Macro-, Meso-, and Micro-Drivers and Interventions for Antibiotic Use and Resistance: A Rapid Evidence Synthesis of Data from Canada and Other OECD Countries. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:5630361. [PMID: 35509517 PMCID: PMC9061047 DOI: 10.1155/2022/5630361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 11/23/2021] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
Hospitals continue to face challenges in reducing incorrect antibiotic use due to social and cultural factors at the level of the health system, the care facility, the provider, and the patient. The objective of this paper is to highlight the social and cultural drivers of antimicrobial use and resistance and targeted interventions for secondary and tertiary care settings in Canada and other OECD countries. This paper is an extension of the synthesis conducted for the Public Health Agency of Canada's 2019 Spotlight Report: Preserving Antibiotics Now and Into the Future. We conducted a systematic review with a few modifications to meet rapid timelines. We conducted a search in Ovid MEDLINE and McMaster University's evidence databases for systematic reviews and then for individual Canadian studies. To cast a wider net, we searched OECD organization websites and screened reference lists from systematic reviews. We synthesized the evidence narratively and categorized the evidence into macro-, meso-, and microlevel. A total of 70 studies were (a) from OCED countries and summarized evidence of potential sociocultural antimicrobial resistance and use barriers or facilitators and/or interventions addressing these challenges; (b) systematic reviews with 50% of included studies that are situated in secondary and tertiary settings; and (c) published in Canada's two official languages, English and French. We found that hospital structures and policies may influence antibiotic utilization and variations in antimicrobial management. Microlevel factors may sway inappropriate prescribing among clinicians. The amount and type of antibiotics used may affect resistance rates. Interventions were mainly comprised of antibiotic stewardship and training that modify clinician behavior and that educate patients and carers. This evidence synthesis illustrates the various drivers of, and interventions for, antimicrobial use and resistance at the macro-, meso-, and microlevel in secondary and tertiary settings. We demonstrate that upstream drivers may lead to downstream events that influence antimicrobial resistance.
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Affiliation(s)
- Rosa Stalteri Mastrangelo
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Anisa Hajizadeh
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Departments of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, ON, Canada
| | - Michael Wilson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Luis Enrique Colunga Lozano
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton, ON, Canada
| | - Yetiani Roldan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton, ON, Canada
| | - Hussein El-Khechen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Anna Miroshnychenko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Priya Thomas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton, ON, Canada
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Dolovich L, Austin Z, Waite N, Chang F, Farrell B, Grindrod K, Houle S, McCarthy L, MacCallum L, Sproule B. Pharmacy in the 21st century: Enhancing the impact of the profession of pharmacy on people's lives in the context of health care trends, evidence and policies. Can Pharm J (Ott) 2018; 152:45-53. [PMID: 30719197 DOI: 10.1177/1715163518815717] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Lisa Dolovich
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Zubin Austin
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Nancy Waite
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Feng Chang
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Barbara Farrell
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Kelly Grindrod
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Sherilyn Houle
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Lori MacCallum
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Beth Sproule
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
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