COVID-19 팬데믹 시기 항생제 적정 사용관리(ASP)의 성과에 대한 체계적 문헌고찰

Abstract

The COVID-19 pandemic significantly disrupted healthcare delivery, potentially affecting antibiotic stewardship program (ASP) implementation and outcomes. This systematic review evaluated the impact of ASP operational status on antibiotic utilization, antimicrobial resistance rates, and clinical outcomes among hospitalized patients during the COVID-19 pandemic. A comprehensive search was conducted across five databases (PubMed, Embase, Cochrane Library, RISS, and KoreaMed) for studies published within the past five years. Primary studies were included if they explicitly reported or allowed determination of ASP operational status during the COVID-19 pandemic and measured at least one outcome of interest: antibiotic utilization, resistance rates, or clinical outcomes. Study quality was assessed using National Institutes of Health (NIH) quality assessment tools. Nine studies met inclusion criteria and were rated as “Fair” quality. ASP operational patterns varied: six studies maintained ASP operations, two experienced temporary suspension followed by resumption, and one reported complete discontinuation. Institutions with operational ASPs demonstrated reduced antibiotic utilization compared to those without active programs. However, resistance patterns and clinical outcomes showed inconsistent results across studies, with considerable heterogeneity in findings. Despite pandemic-related healthcare disruptions, ASPs remained effective in promoting appropriate antibiotic use. Future research should prioritize developing adaptive ASP frameworks suitable for diverse healthcare environments and establishing robust policy infrastructure to ensure program continuity during healthcare emergencies.