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Updated: Jan 17, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Antimicrobial stewardship interventions in adults with hospital-acquired pneumonia: a systematic review and
Nurgul Ablakimova1, Svetlana Rachina2, Daria Strelkova2
1Department of Pharmacology, Clinical Pharmacology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan; Department of Hospital Pharmacy, Aktobe Regional Perinatal Center, Aktobe, Kazakhstan.
Background:
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) represent the most severe healthcare-associated infections (HAIs), characterized by high morbidity, mortality and antimicrobial resistance rates.
Aim:
The aim of this study was to systematically assess the impact of antimicrobial stewardship and diagnostic interventions on clinical, microbiological and process outcomes in adult patients with HAP/VAP.
Methods:
A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (International Prospective Register of Systematic Reviews registration number: CRD42023492494). PubMed, Scopus and Web of Science databases were searched for studies published from 2000 to May 2025. Eligible designs included randomized trials, quasi-experimental and before-and-after studies involving adults with HAP or VAP. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were estimated using random-effect models in R (meta package).
Findings:
Nineteen studies were included, of which 11 were meta-analysed. Antimicrobial stewardship programme (ASP) interventions significantly reduced the duration of antibiotic therapy (SMD = -1.02; 95% confidence interval [CI]: -1.76 to -0.28; P = 0.007). A significant improvement was also observed for protocol adherence (OR = 5.91; 95% CI: 1.26-27.67; P = 0.024). No statistically significant differences were found for hospital mortality (OR = 0.73; 95% CI: 0.51-1.05; P = 0.088), 30-day in-hospital mortality (OR = 1.13; 95% CI: 0.73-1.76; P = 0.58), length of intensive care unit (ICU) stay or ventilator-free days. Heterogeneity was high across designs.
Conclusion:
Stewardship interventions for HAP/VAP safely shorten antibiotic duration and improve adherence to clinical protocols without compromising patient safety. To achieve more meaningful clinical impact, future ASP models should integrate diagnostics, pharmacokinetic/pharmacodynamic-guided dosing and ventilator-care bundles within multi-disciplinary ICU frameworks.
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