Drivers of inappropriate use of antimicrobials in South Asia: A systematic review of qualitative literature.
Drivers of inappropriate use of antimicrobials in South Asia: A systematic review of qualitative literature.
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南亚不当使用抗菌药物的驱动因素：定性文献的系统回顾。
DOI：
10.1101/2023.09.28.23296313
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Watt,MelissaH
中科院分区：
文献类型：
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作者：
Murray,JenniferL;Leung,DanielT;Hanson,OliviaR;Ahmed,ShariaM;Pavia,AndrewT;Khan,AshrafulI;Szymczak,JuliaE;Vaughn,ValerieM;Patel,PayalK;Biswas,Debashish;Watt,MelissaH
抗生素耐药性是一个全球性的公共卫生危机。有效的抗菌药物管理需要了解导致抗菌药物不适当使用的因素和背景。这项定性系统性综述的目标是综合社会生态框架各个层面的主题，这些主题导致南亚地区抗菌药物的不适当使用。2023年9月，我们使用电子数据库PubMed和Embase进行了系统检索。检索词，identifieda先验，相关的研究方法，主题和地理位置。我们从初始检索中识别出165篇文章，在参考文献审查时识别出8篇文章（n = 173）;在删除重复和预印本（n = 12）并排除不符合资格标准的文章（n = 115）后，46篇文章被纳入审查。我们使用定性的关键评估技能计划检查表评估方法的质量。这些研究代表了南亚的6个国家，包括来自患者、医疗保健提供者、社区成员和政策制定者的数据。对于每一篇手稿，我们都写了一份总结备忘录，以提取阻碍抗菌药物管理的因素。我们使用NVivo软件对备忘录进行编码;代码按社会生态框架的层次进行组织。在包括患者在内的多个层面上确定了障碍（抗菌剂自我治疗;抗菌剂的感知价值），提供者（抗菌剂作为一种通用疗法;知识和技能差距;财务或声誉激励），临床环境（缺乏资源;设施管理不善），社区（获得正规医疗保健;非正规药品供应商;社会规范）和政策（缺乏监管框架;现有政策执行不力）。这项研究是第一个简洁地确定了一系列规范，行为和政策背景，推动南亚不适当使用抗菌药物，强调跨多个部门合作设计和实施该地区特定方法的重要性。
Antimicrobial resistance is a global public health crisis. Effective antimicrobial stewardship requires an understanding of the factors and context that contribute to inappropriate use of antimicrobials. The goal of this qualitative systematic review was to synthesize themes across levels of the social ecological framework that drive inappropriate use of antimicrobials in South Asia. In September 2023, we conducted a systematic search using the electronic databases PubMed and Embase. Search terms, identifieda priori, were related to research methods, topic, and geographic location. We identified 165 articles from the initial search and 8 upon reference review (n = 173); after removing duplicates and preprints (n = 12) and excluding those that did not meet eligibility criteria (n = 115), 46 articles were included in the review. We assessed methodological quality using the qualitative Critical Appraisal Skills Program checklist. The studies represented 6 countries in South Asia, and included data from patients, health care providers, community members, and policy makers. For each manuscript, we wrote a summary memo to extract the factors that impede antimicrobial stewardship. We coded memos using NVivo software; codes were organized by levels of the social ecological framework. Barriers were identified at multiple levels including the patient (self-treatment with antimicrobials; perceived value of antimicrobials), the provider (antimicrobials as a universal therapy; gaps in knowledge and skills; financial or reputational incentives), the clinical setting (lack of resources; poor regulation of the facility), the community (access to formal health care; informal drug vendors; social norms), and policy (absence of a regulatory framework; poor implementation of existing policies). This study is the first to succinctly identify a range of norms, behaviors, and policy contexts driving inappropriate use of antimicrobials in South Asia, emphasizing the importance of working across multiple sectors to design and implement approaches specific to the region.