Antimicrobial resistance and mitigation strategies in healthcare settings: A scoping review

BackgroundAccording to the European Center for Disease Prevention and Control (ECDC), the EU records an estimated 3.2 million healthcare associated infections (HAIs) and an associated 37,000 deaths annually. A significant proportion of the HAIs burden is attributable to multi-drug resistant organisms (MDROs). Infectious diseases remain top on the list of the leading causes of death globally with MDROs playing a significant role. Key amongst these organisms is Clostridium difficile and Klebsiella pneumoniae which belong to the broader group of ESKAPE pathogens. AimsThis review aimed at identifying literature on interventions targeting Clostridium difficile and Klebsiella pneumoniae, their key outcomes, and the extent to which behavioural theory has been applied in such interventions. MethodsThis scoping review was undertaken and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. The specific databases searched included MEDLINE, PubMed, Web of Science Core Collection, and CINAHL. The process for screening articles and data extraction was undertaken in duplicate by two reviewers. A narrative synthesis of the results is provided. ResultsThe review included 34 studies (16 studies on Clostridium difficile and 18 articles focussed on Klebsiella pneumoniae). The specific antimicrobial stewardship interventions identified include Education, Surveillance and Screening, Consultations, Audits, Policies and Protocols, Environmental measures, Bundles of care, Isolation precautions, as well as Notifications and alerts systems (ESCAPE-BIN). The identified outcomes include antimicrobial use, resistance rates, risk reduction, adherence to contact precautions, hospital stay, and time savings. Only one study incorporated Kotters stages of behaviour change and recorded the second largest (75%) sustained reduction in antimicrobials use whereas the remainder of the studies were devoid of behavioural approaches. The highest improvement (95%) in adherence isolation precautions was reported by an intervention involving the use of an IPC bundle and an environmental cleaning protocol. ConclusionThis scoping review identified the available evidence on antimicrobial the mitigation strategies for Clostridium difficile and Klebsiella pneumoniae in healthcare settings as well as the key outcomes. There is need for further investigations on the feasibility of behaviour-based approaches in improving adherence of health workers to interventions targeting Clostridium difficile and Klebsiella pneumoniae.