Impact of pharmacist-led antibiotic stewardship audit-feedback intervention; systematic review and meta-analysis

The escalating threat of antimicrobial resistance continues to burden healthcare systems globally. Antimicrobial stewardship programs (ASPs) are recognized as a cornerstone strategy to mitigate inappropriate antibiotic use and curb resistance. Despite their growing implementation, the impact of pharmacist-led audit and feedback interventions within ASPs remains insufficiently explored.

To synthesize the evidence on the effect of pharmacist-led audit-feedback interventions within ASPs.

In accordance with PRISMA guidelines, the pooled estimate of pharmacist-led ASP audit-feedback interventions was calculated using a random-effects model. The Cochrane risk of bias tools were employed to assess the quality of the studies. We searched PubMed, SCOPUS, EBSCO/CINAHL, and Web of Science from January 1, 2000, to June 30, 2024. We included randomized controlled trials, cohort studies, case-control studies, and quasi-experimental studies. Sensitivity analyses were conducted using the leave-one-out method. Publication bias was assessed through funnel plot and Egger's regression test. Study protocol registered with PROSPERO (CRD420251036088).

A total of 69,666 studies were screened, with 14 ultimately included in the final qualitative and quantitative analysis. Including 17805 patients in the pooled analysis. Pharmacist-led ASP audit-feedback intervention associated with reduction in antibiotic days of therapy, length of hospital stay (MD = -5.93, 95 % CI -12.90-1.03, I² 97.7 %), significant increase in appropriate antibiotic prescribing practice (OR 2.72, 95 % CI 1.51-4.88, I² 75 %) and 25 % reduction in mortality (OR 0.75, 95 % CI 0.55-1.03, I² 88 %) CONCLUSION: This systematic review and meta-analysis provide growing evidence that pharmacist-led audit and feedback interventions within ASPs are associated with a significant improvement in appropriate antibiotic prescribing and reduction in mortality, length of hospital stay, and days of therapy. These findings support the integration of pharmacists as key leaders in ASPs and highlight the potential for policymakers to prioritize investment in pharmacist-led stewardship roles.