Abstract：
Antimicrobial stewardship (AMS) interventions to improve antibiotic use are being implemented in Africa, but their impact is not fully known. The aim of this review was to estimate the effectiveness of interventions to improve antibiotic prescribing for hospital inpatients. Studies from PubMed, Embase, African Journals Online and Google Scholar were systematically searched from January 2010 to July 2022. Studies were included if they reported the impact of AMS interventions on outcomes of interest for hospital inpatients in Africa. Risk of bias was evaluated using the Cochrane Effective Practice and Organization of Care guidelines and the National Heart, Lung and Blood Institute tool. Findings were summarized in tables and meta-analyses were performed using random-effects models. A total of 28 studies were included, 89% being uncontrolled before and after studies. Most interventions employed were multi-faceted and found to be effective, evidenced by increased compliance, reduction in antibiotic utilization and cost, and slight reduction or no difference in mortality and length of hospital stay (LOS). Meta-analysis generated a relative risk of 0.82 [95% confidence interval (CI) 0.70-0.97] for mortality, and a standard mean difference of -0.30 (95% CI -0.41 to -0.19) for LOS. Generally, a decrease in resistance to most micro-organisms was observed. Despite an increase in the number of AMS studies conducted in Africa, the studies lack most of the quality design features for AMS studies. In conclusion, antimicrobial stewardship interventions are likely to be effective; however, efforts are still required to align the study design with the quality design features required for validity and to inform practice.
摘要：
非洲正在实施抗生素管理（AMS）干预措施，以改善抗生素的使用。但其影响尚不完全清楚。这篇综述的目的是评估干预措施的有效性，以改善住院患者的抗生素处方。PubMed的研究,Embase,从2010年1月至2022年7月，系统地搜索了非洲在线期刊和GoogleScholar。如果研究报告了AMS干预措施对非洲住院患者感兴趣的结果的影响，则将其包括在内。使用CochraneEffectivePracticeandOrganizationofCareguidelinesandtheNationalHeart,肺和血液研究所的工具。研究结果汇总在表格中，并使用随机效应模型进行荟萃分析。共纳入28项研究，89%的人在研究前后都不受控制。采用的大多数干预措施都是多方面的，被认为是有效的，证明了合规性的增加，减少抗生素的使用和成本，死亡率和住院时间（LOS）略有减少或无差异。荟萃分析得出的死亡率相对风险为0.82[95%置信区间(CI)0.70-0.97]，LOS的标准平均差为-0.30(95%CI-0.41至-0.19)。一般来说,观察到对大多数微生物的抗性降低。尽管在非洲进行的AMS研究数量有所增加，这些研究缺乏AMS研究的大多数质量设计特征。总之,抗菌药物管理干预措施可能是有效的；然而，仍然需要努力使研究设计与有效性所需的质量设计特征保持一致，并为实践提供信息。
