Audit and Feedback Interventions for Antibiotic Prescribing in Primary Care: A Systematic Review and Meta-analysis

作者：Alice X T Xu, Kevin A. Brown, Kevin L. Schwartz, Soheila Aghlmandi, Sarah Alderson, Jamie C Brehaut, Benjamin Brown, Heiner C. Bucher, Jan Clarkson, An De Sutter, Nick Francis, Jeremy Grimshaw, Ronny Gunnarsson, Michael Hallsworth, Lars G. Hemkens, Sigurd Høye, Tasneem Khan, Donna M Lecky, Felicia Leung, Jeremy Leung, Morten Lindbæk, Jeffrey A. Linder, Carl Llor, Paul Little, Denise O’Connor, C. Pulcini, Kalisha Ramlackhan, Craig Ramsay, Pär‐Daniel Sundvall, Monica Taljaard, P Touboul, Akke Vellinga, Jan Y. Verbakel, Theo Verheij, Carl Wikberg, Noah Ivers · 发表于：Clinical Infectious Diseases · 年份：2024 · DOI：10.1093/cid/ciae604 · 被引用次数：40 · 研究领域：Antibiotic Use and Resistance、Antibiotics Pharmacokinetics and Efficacy、Urinary Tract Infections Management

BACKGROUND: This systematic review evaluates the effect of audit and feedback (A&F) interventions targeting antibiotic prescribing in primary care and examines factors that may explain the variation in effectiveness. METHODS: Randomized controlled trials (RCTs) involving A&F interventions targeting antibiotic prescribing in primary care were included in the systematic review. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and ClinicalTrials.gov were searched up to May 2024. Trial, participant, and intervention characteristics were extracted independently by 2 researchers. Random effects meta-analyses of trials that compared interventions with and without A&F were conducted for 4 outcomes: (1) total antibiotic prescribing volume; (2) unnecessary antibiotic initiation; (3) excessive prescription duration, and (4) broad-spectrum antibiotic selection. A stratified analysis was also performed based on study characteristics and A&F intervention design features for total antibiotic volume. RESULTS: A total of 56 RCTs fit the eligibility criteria and were included in the meta-analysis. A&F was associated with an 11% relative reduction in antibiotic prescribing volume (N = 21 studies, rate ratio [RR] = 0.89; 95% confidence interval [CI]: .84, .95; I2 = 97); 23% relative reduction in unnecessary antibiotic initiation (N = 16 studies, RR = 0.77; 95% CI: .68, .87; I2 = 72); 13% relative reduction in prolonged duration of antibiotic course (N = 4 studies, RR = 0....