BACKGROUND 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, data concerning their potential effectiveness have not been methodically collected and evaluated to date. AIM To identify, collect and evaluate the available evidence regarding the impact of restrictive policies on bacterial resistance in hospital settings. METHODS A systematic literature review was conducted using the PubMed/Medline, Embase, Global Health and CINAHL Plus databases. FINDINGS In total, 5555 papers were retrieved in the search process, and 29 studies were included in the final analysis. There were no randomized studies, 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 the control of vancomycin-resistant enterococci, while carbapenem stewardship in the form of the preferred use of ertapenem 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 to high-risk departments. Carbapenem-resistant Acinetobacter baumannii might be difficult to control through solely formulary interventions. CONCLUSION The presumably effective restrictive strategies rely mainly on inadequately tested hypotheses and low-quality evidence. Therefore, systematic, high-quality research is needed to confirm and expand comprehension of the subject so that the most successful policies are employed in the field.

中文翻译：

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抗菌药物限制在细菌耐药性控制中的作用：系统的文献综述。

背景技术抗菌管理被认为是细菌耐药性控制的最基本方面之一。在众多举措中，限制性策略已在医院环境中广泛实施。但是，到目前为止，尚未有系统地收集和评估有关其潜在效力的数据。目的确定，收集和评估有关限制性政策对医院环境中细菌耐药性的影响的现有证据。方法使用PubMed / Medline，Embase，Global Health和CINAHL Plus数据库进行系统的文献综述。结果在搜索过程中总共检索到5555篇论文，最终分析中包括29项研究。没有随机研究，而且所采用的观测设计的固有局限性阻碍了对安全结论的推论。看来有益的干预措施包括限制广谱头孢菌素的使用，以支持β-内酰胺/内酰胺酶抑制剂的结合以及限制氟喹诺酮类药物的使用。抗菌药物的限制也可能在耐万古霉素的肠球菌的控制中发挥作用，而以首选厄他培南使用形式的碳青霉烯类药物的管理并没有产生预期的结果。没有为复杂的比较分析提供复杂的限制。医院范围内的政策可能优于局限在高风险部门的政策。单纯通过处方干预可能难以控制对碳青霉烯类耐药的鲍曼不动杆菌。结论可能有效的限制性策略主要依赖于未充分检验的假设和低质量的证据。因此，需要系统，高质量的研究来确认和扩大对这一主题的理解，以便在该领域采用最成功的政策。