PDF(Pubmed)
Abstract：
Vaccination can prevent bacterial and viral infections that could otherwise increase the chances of receiving (unnecessary) antibiotic treatment(s). As a result, vaccination may provide an important public health intervention to control antimicrobial resistance (AMR).
Perform a systematic literature review to better understand the impact of influenza, pneumococcal and COVID-19 vaccination on antibiotic use, and to identify differences in effect between world regions and study designs.
We performed a systematic literature review and meta-analysis which updated previous literature reviews with new data from 1 October 2018 to 1 December 2021. The study focuses on randomised controlled trials (RCTs) and observational studies. Results from the meta-analysis of RCTs were stratified by WHO region and age group. Vote counting based on the direction of effect was applied to synthesize the results of the observational studies.
Most studies are performed in the WHO European Region and the Region of the Americas in high-income countries. RCTs show that the effect of influenza vaccination on the number of antibiotic prescriptions or days of antibiotic use (Ratio of Means (RoM) 0.71, 95% CI 0.62-0.83) is stronger compared to the effect of pneumococcal vaccination (RoM 0.92, 95% CI 0.85-1.00). These studies also confirm a reduction in the proportion of people receiving antibiotics after influenza vaccination (Risk Ratio (RR) 0.63, 95% CI 0.51-0.79). The effect of influenza vaccination in the European and American regions ranged from RoM 0.63 and 0.87 to RR 0.70 and 0.66, respectively. The evidence from observational studies supports these findings but presents a less consistent picture. No COVID-19 studies were identified.
We find that both RCTs and observational studies show that influenza vaccination significantly reduces antibiotic use, while the effect of pneumococcal vaccination is less pronounced. We were unable to study the effect of COVID-19 vaccination and no clear regional patterns were found due to the high heterogeneity between studies. Overall, our data supports the use of influenza vaccination as an important public health intervention to reduce antibiotic use and possibly control AMR.
Perform a systematic literature review to better understand the impact of influenza, pneumococcal and COVID-19 vaccination on antibiotic use, and to identify differences in effect between world regions and study designs.
We performed a systematic literature review and meta-analysis which updated previous literature reviews with new data from 1 October 2018 to 1 December 2021. The study focuses on randomised controlled trials (RCTs) and observational studies. Results from the meta-analysis of RCTs were stratified by WHO region and age group. Vote counting based on the direction of effect was applied to synthesize the results of the observational studies.
Most studies are performed in the WHO European Region and the Region of the Americas in high-income countries. RCTs show that the effect of influenza vaccination on the number of antibiotic prescriptions or days of antibiotic use (Ratio of Means (RoM) 0.71, 95% CI 0.62-0.83) is stronger compared to the effect of pneumococcal vaccination (RoM 0.92, 95% CI 0.85-1.00). These studies also confirm a reduction in the proportion of people receiving antibiotics after influenza vaccination (Risk Ratio (RR) 0.63, 95% CI 0.51-0.79). The effect of influenza vaccination in the European and American regions ranged from RoM 0.63 and 0.87 to RR 0.70 and 0.66, respectively. The evidence from observational studies supports these findings but presents a less consistent picture. No COVID-19 studies were identified.
We find that both RCTs and observational studies show that influenza vaccination significantly reduces antibiotic use, while the effect of pneumococcal vaccination is less pronounced. We were unable to study the effect of COVID-19 vaccination and no clear regional patterns were found due to the high heterogeneity between studies. Overall, our data supports the use of influenza vaccination as an important public health intervention to reduce antibiotic use and possibly control AMR.
摘要：
背景：疫苗接种可以预防细菌和病毒感染，否则可能会增加接受（不必要的）抗生素治疗的机会。因此,疫苗接种可能为控制抗菌素耐药性（AMR）提供重要的公共卫生干预措施。
目的：进行系统的文献综述，以更好地了解流感的影响，肺炎球菌和COVID-19疫苗接种抗生素，并确定世界区域和研究设计之间的效果差异。
方法：我们进行了系统的文献综述和荟萃分析，用2018年10月1日至2021年12月1日的新数据更新了以前的文献综述。该研究侧重于随机对照试验（RCT）和观察性研究。RCT的荟萃分析结果按WHO地区和年龄组进行分层。基于效果方向的投票计数用于综合观察性研究的结果。
结果：大多数研究是在世卫组织欧洲区域和美洲区域的高收入国家进行的。RCT显示，与肺炎球菌疫苗接种（RoM0.92，95％CI0.85-1.00）相比，流感疫苗接种对抗生素处方数量或抗生素使用天数的影响（均值比率（RoM）0.71，95％CI0.62-0.83）更强。这些研究还证实了流感疫苗接种后接受抗生素治疗的人群比例降低（风险比（RR）0.63，95％CI0.51-0.79）。在欧洲和美洲地区，流感疫苗接种的效果分别从RoM0.63和0.87到RR0.70和0.66。观察性研究的证据支持这些发现，但呈现的情况不太一致。没有确定COVID-19研究。
结论：我们发现随机对照试验和观察性研究均表明，流感疫苗接种可显著减少抗生素的使用，而肺炎球菌疫苗接种的效果不太明显。我们无法研究COVID-19疫苗接种的效果，由于研究之间的高度异质性，也没有发现明确的区域模式。总的来说,我们的数据支持将流感疫苗接种作为减少抗生素使用并可能控制AMR的重要公共卫生干预措施.
目的：进行系统的文献综述，以更好地了解流感的影响，肺炎球菌和COVID-19疫苗接种抗生素，并确定世界区域和研究设计之间的效果差异。
方法：我们进行了系统的文献综述和荟萃分析，用2018年10月1日至2021年12月1日的新数据更新了以前的文献综述。该研究侧重于随机对照试验（RCT）和观察性研究。RCT的荟萃分析结果按WHO地区和年龄组进行分层。基于效果方向的投票计数用于综合观察性研究的结果。
结果：大多数研究是在世卫组织欧洲区域和美洲区域的高收入国家进行的。RCT显示，与肺炎球菌疫苗接种（RoM0.92，95％CI0.85-1.00）相比，流感疫苗接种对抗生素处方数量或抗生素使用天数的影响（均值比率（RoM）0.71，95％CI0.62-0.83）更强。这些研究还证实了流感疫苗接种后接受抗生素治疗的人群比例降低（风险比（RR）0.63，95％CI0.51-0.79）。在欧洲和美洲地区，流感疫苗接种的效果分别从RoM0.63和0.87到RR0.70和0.66。观察性研究的证据支持这些发现，但呈现的情况不太一致。没有确定COVID-19研究。
结论：我们发现随机对照试验和观察性研究均表明，流感疫苗接种可显著减少抗生素的使用，而肺炎球菌疫苗接种的效果不太明显。我们无法研究COVID-19疫苗接种的效果，由于研究之间的高度异质性，也没有发现明确的区域模式。总的来说,我们的数据支持将流感疫苗接种作为减少抗生素使用并可能控制AMR的重要公共卫生干预措施.
