Documentation of exclusion rationales.

The global antibiotic resistance crisis necessitates optimized stewardship programs, with telemedicine emerging as a promising delivery strategy. This systematic review evaluated the effectiveness of telemedicine interventions in improving antibiotic stewardship across clinical settings. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched seven databases from January 2010 to July 2024. Two independent reviewers assessed studies using Risk of Bias in Non-randomized Studies (ROBINS-I) and Cochrane Risk of Bias 2.0 tools, with evidence certainty evaluated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Twenty-one studies met inclusion criteria (10 observational, 8 quasi-experimental, 2 Randomized Controlled Trials [RCTs], 1 mixed-methods), predominantly from the United States (57.0%, n = 12). Among studies reporting antibiotic use outcomes (52.4%, n = 11), 90.9% demonstrated significant reductions ranging from 5.3% to 62.7%, with the highest-quality evidence showing a 28% reduction (95% Confidence Interval [CI]: 22-34%). Guideline adherence studies (57.1%, n = 12) showed acceptance rates of 67.7% to 98%, with comparable effectiveness between telemedicine and in-person consultation (79.1% vs 80.4%, p = 0.36). Prescribing rate outcomes (38.1%, n = 8) revealed setting-dependent variations: inpatient implementations demonstrated significant reductions (Relative Risk [RR] 0.68; 95% CI: 0.63-0.75), while outpatient findings showed mixed results. Quality assessment revealed predominantly low risk of bias [ROB] (66.7%, n = 14). These findings suggest that telemedicine effectively improves antibiotic stewardship compared to traditional care models, particularly in hospital settings, while outpatient applications demonstrated variable effectiveness. This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023454663).

全球抗生素耐药性危机亟需优化的抗菌药物管理（Antibiotic Stewardship）方案，而远程医疗正成为极具前景的实施策略。本系统综述评估了远程医疗干预在不同临床场景下改善抗菌药物管理的效果。本研究遵循《系统综述与Meta分析优先报告条目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）指南，系统检索了2010年1月至2024年7月间的7个数据库。由2名独立研究者分别使用非随机研究偏倚风险评价工具（Risk of Bias in Non-randomized Studies, ROBINS-I）与Cochrane偏倚风险2.0工具对纳入研究进行偏倚风险评估，并采用推荐意见分级、制定与评价系统（Grading of Recommendations Assessment, Development, and Evaluation, GRADE）对证据质量进行分级。最终有21项研究符合纳入标准，其中包括10项观察性研究、8项类实验研究、2项随机对照试验（Randomized Controlled Trials, RCTs）及1项混合方法研究，研究主体来自美国（占比57.0%，n=12）。在报告抗生素使用结局的研究（占比52.4%，n=11）中，90.9%的研究显示抗生素使用量显著降低，降幅范围为5.3%至62.7%；其中高质量证据显示抗生素使用量降低28%（95%置信区间（Confidence Interval, CI）：22~34%）。在报告指南依从性的研究（占比57.1%，n=12）中，指南依从率范围为67.7%至98%；远程医疗与线下问诊的干预效果相当（79.1% vs 80.4%，p=0.36）。在报告处方率结局的研究（占比38.1%，n=8）中，结果呈现场景依赖性差异：住院场景下的干预可显著降低处方率（相对风险（Relative Risk, RR）=0.68；95%置信区间：0.63~0.75），而门诊场景下的结果则呈现异质性。质量评估结果显示，大部分研究的偏倚风险较低（占比66.7%，n=14）。上述结果表明，相较于传统诊疗模式，远程医疗可有效改善抗菌药物管理效果，尤其在住院场景中表现显著；而门诊场景下的应用效果则存在差异。本系统综述已在国际系统综述前瞻性注册平台（International Prospective Register of Systematic Reviews, PROSPERO）注册，注册号为CRD42023454663。