The Role of Antimicrobial Restrictions in Bacterial Resistance Control: A Systematic Literature Review.

Antimicrobial stewardship is considered as one of the most fundamental aspects of bacterial resistance control. Among the multitude of initiatives, restrictive strategies have been widely practiced in hospital settings. However, the data concerning their potential effectiveness has not been methodically collected and evaluated so far.To identify, collect and evaluate the available evidence regarding the impact of restrictive policies on bacterial resistance in hospital settings.A systematic literature review was conducted in the PubMed/Medline, Embase, Global Health and CINAHL Plus databases.A total of 5,555 papers were retrieved in the search process and 29 studies were finally included in analysis. Randomised studies were absent and the inherent limitations of the observational designs employed impede the deduction of safe conclusions. Seemingly beneficial interventions encompass the restriction of broad-spectrum cephalosporins in favour of beta-lactam/lactamase-inhibitor combinations as well as the restriction of fluoroquinolones. Antimicrobial restrictions might also play a role in VRE control while carbapenem stewardship in the form of preferred ertapenem use did not produce the anticipated results. Complex restrictions are not offered for informative comparative analyses. Hospital-wide policies could perhaps be superior to those confined in high-risk departments. Carbapenem-resistant A. baumannii might be difficult to control through solely formulary interventions.The presumably effective restrictive strategies rely mostly on inadequately tested hypotheses and low-quality evidence. Therefore, systematic, high-quality research is needed to confirm and expand our comprehension of the subject so that the most successful policies are actually employed on the field.