Priority 5 from the Healthcare Associated Infections PSP

UNCERTAINTY: Can antibiotic stewardship policies (including decreased antibiotic prescription) decrease antibiotic resistance, and do they cause any harm to the patients? (Priority 5)
Overall ranking	5
JLA question ID	0088/5
Explanatory note	Not available
Evidence	Systematic review: Bertollo et al. Am J Infect Control. 2018 Jul;46(7):824-836. Araujo da Silva et al. J Hosp Infect. 2018 Jun;99(2):117-123 Baur et al. Lancet Infect Dis. 2017 Sep;17(9):990-1001 Losier et al. Ann Pharmacother. 2017 Sep;51(9):774-790 Davey et al. Cochrane Database Syst Rev. 2017 Feb 9;2:CD003543. Systematic review details: Bertollo, Araujo da Silva, and Losier: More studies of appropriate study designs are necessary Baur: Ignores the risk of bias in the studies and concluded that antimicrobial stewardship is effective Davey: Antibiotic stewardship interventions probably reduces length of stay by one day (moderate-certainty evidence), but may lead to delay in treatment and negative professional culture because of breakdown in communication and trust between infection specialists and clinical teams (low-certainty evidence). The other conclusions about antibiotic stewardship do not seem to fit in with the findings
Health Research Classification System category	Infection

Extra information provided by this project
Original uncertainty examples	Do hospital antimicrobial stewardship policies reduce community rates of antibiotic resistance? ~ How much reduction in antimicrobial use is required to reduce levels of resistance?
Submitted by	2 x Health Professional, 1 x Patient

Project information
Project unique ID	0088
Project name	Healthcare Associated Infections
Total number of uncertainties identified by this project.	259 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	28 February 2019