Impact of antimicrobial stewardship interventions on prescribing and patient outcomes among dialysis patients: a systematic review

Background There is limited evidence describing the impact of antimicrobial stewardship (AMS) interventions among dialysis patients.Objectives To evaluate the impact of AMS interventions on antibiotic prescribing, clinical, economic and microbiological outcomes among dialysis patients.Methods An electronic search was conducted in PubMed and Scopus databases to identify published studies in English. Studies that assessed the impact of AMS on antibiotic prescribing among dialysis patients from the inception of the databases to 19th January 2025 were included. At least two independent reviewers screened, selected and extracted data from the included studies for a qualitative synthesis. Disagreements between the reviewers were resolved through consensus or by a third reviewer.Results Electronic search of the databases identified 2036 articles, out of which five articles describing four studies were included. Three studies had inpatients, while one study included outpatient hemodialysis patients. Multiple AMS interventions were implemented; prospective audit with feedback (n = 3), educational intervention (n = 2) and pharmacists’ participation in ward rounds (n = 1) were the most common interventions. AMS interventions reduced inappropriate antimicrobial dosing in two studies. One study found that dose adjustment (17.2%) was the second most accepted AMS intervention among prescribers. A significant 6% monthly reduction in antimicrobial doses/100 patient months was reported in another study. There is limited evidence to describe the impact of AMS interventions on clinical outcomes; few studies reported no significant changes in mortality, length of stay, readmission rate and infection/colonization with multidrug-resistant organisms.Conclusions Limited low-certainty evidence indicates that AMS interventions improved antibiotic dosing among dialysis patients and reduced antibiotic use. The impact of AMS on clinical, economic and microbial outcomes requires further investigation.