Abstract：
OBJECTIVE: We sought to characterize and evaluate the effectiveness of pharmacist-led AMS interventions in improving antimicrobial use and subsequent surgical site infections (SSI) in perioperative settings.
METHODS: A systematic review and meta-analysis was conducted by searching PubMed, Embase and CINAHL. Two independent reviewers extracted the data using the Descriptive Elements of Pharmacist Intervention Characterization Tool and undertook quality assessment using the Crowe Critical Appraisal. A meta-analysis was conducted using a random-effect model.
RESULTS: Eleven studies were included in this review. Pharmacists were found to have various roles in AMS, including educational sessions, ward rounds, audits and feedback, and guidelines development. The discussion of interventions lacked details on the development. A meta-analysis revealed that pharmacist-led AMS programs in perioperative settings was associated with a significant improvement in antibiotic selection (OR 4.29; 95 % CI 2.52-7.30), administration time (OR 4.93; 95 % CI 2.05-11.84), duration (OR 5.27; 95 % CI 1.58-17.55), and SSI (OR 0.51; 95 % CI 0.34-0.77).
CONCLUSIONS: Pharmacist-led AMS programs were effective in improving antimicrobial prescribing while reducing SSI; however most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions, therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. High-quality, multicomponent, theory-derived, interventional studies using appropriate methodology and standardized data collection, are needed.
METHODS: A systematic review and meta-analysis was conducted by searching PubMed, Embase and CINAHL. Two independent reviewers extracted the data using the Descriptive Elements of Pharmacist Intervention Characterization Tool and undertook quality assessment using the Crowe Critical Appraisal. A meta-analysis was conducted using a random-effect model.
RESULTS: Eleven studies were included in this review. Pharmacists were found to have various roles in AMS, including educational sessions, ward rounds, audits and feedback, and guidelines development. The discussion of interventions lacked details on the development. A meta-analysis revealed that pharmacist-led AMS programs in perioperative settings was associated with a significant improvement in antibiotic selection (OR 4.29; 95 % CI 2.52-7.30), administration time (OR 4.93; 95 % CI 2.05-11.84), duration (OR 5.27; 95 % CI 1.58-17.55), and SSI (OR 0.51; 95 % CI 0.34-0.77).
CONCLUSIONS: Pharmacist-led AMS programs were effective in improving antimicrobial prescribing while reducing SSI; however most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions, therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. High-quality, multicomponent, theory-derived, interventional studies using appropriate methodology and standardized data collection, are needed.
摘要：
目的：我们试图描述和评估药师主导的AMS干预措施在改善围手术期抗菌药物使用和随后手术部位感染（SSI）方面的有效性。
方法：通过搜索PubMed，Embase和CINAHL。两名独立的审阅者使用药剂师干预表征工具的描述性要素提取数据，并使用CroweCriticalAssessment进行质量评估。使用随机效应模型进行荟萃分析。
结果：本综述包括11项研究。药剂师被发现在AMS中扮演各种角色，包括教育会议，查房,审计和反馈，和指导方针的发展。关于干预措施的讨论缺乏关于发展的细节。一项荟萃分析显示，在围手术期环境中，药剂师主导的AMS计划与抗生素选择的显着改善相关（OR4.29;95％CI2.52-7.30），给药时间（OR4.93；95%CI2.05-11.84），持续时间（OR5.27；95%CI1.58-17.55），和SSI（OR0.51；95%CI0.34-0.77）。
结论：药剂师主导的AMS项目可有效改善抗菌药物处方，同时降低SSI；然而，大多数研究质量中等。研究缺乏利用理论来发展干预措施，因此,目前尚不清楚基于理论的干预措施是否比没有理论因素的干预措施更有效。高品质，多组分,理论推导，使用适当方法和标准化数据收集的介入研究，是需要的。
方法：通过搜索PubMed，Embase和CINAHL。两名独立的审阅者使用药剂师干预表征工具的描述性要素提取数据，并使用CroweCriticalAssessment进行质量评估。使用随机效应模型进行荟萃分析。
结果：本综述包括11项研究。药剂师被发现在AMS中扮演各种角色，包括教育会议，查房,审计和反馈，和指导方针的发展。关于干预措施的讨论缺乏关于发展的细节。一项荟萃分析显示，在围手术期环境中，药剂师主导的AMS计划与抗生素选择的显着改善相关（OR4.29;95％CI2.52-7.30），给药时间（OR4.93；95%CI2.05-11.84），持续时间（OR5.27；95%CI1.58-17.55），和SSI（OR0.51；95%CI0.34-0.77）。
结论：药剂师主导的AMS项目可有效改善抗菌药物处方，同时降低SSI；然而，大多数研究质量中等。研究缺乏利用理论来发展干预措施，因此,目前尚不清楚基于理论的干预措施是否比没有理论因素的干预措施更有效。高品质，多组分,理论推导，使用适当方法和标准化数据收集的介入研究，是需要的。
