Antimicrobial stewardship resourcing and programme outcomes: a scoping review

Area of Science:

• Health Services Research
• Infectious Diseases
• Health Economics

Background:

• Antimicrobial resistance (AMR) necessitates effective antimicrobial stewardship programmes (ASPs).
• Limited human and financial resources hinder ASP implementation and effectiveness.
• The precise relationship between ASP resourcing levels and patient, programmatic, and economic outcomes requires clarification.

Purpose of the Study:

• To conduct a scoping review of evidence associating antimicrobial stewardship programme (ASP) resourcing with key outcomes.
• To identify and synthesize data on how different levels of resource allocation impact antimicrobial use, patient health, program implementation, and economic factors.

Main Methods:

• A comprehensive scoping review following PRISMA-ScR guidelines.
• Searches of major databases (Medline, EMBASE, Scopus, CINAHL) and grey literature.
• Duplicate screening and data extraction, with quality assessment using Joanna Briggs Institute tools.

Main Results:

• 32 studies were included, primarily observational and from high-income countries.
• Increased ASP resourcing was linked to reduced antimicrobial use (81% of studies), improved process outcomes (89%), and reduced costs (100%).
• Clinical and microbiological outcomes showed improvement in 43% of studies, indicating heterogeneous evidence.

Conclusions:

• Enhanced ASP resourcing shows a positive association with improved antimicrobial use and economic outcomes.
• Heterogeneity in evidence highlights the need for more rigorous, prospective research.
• Evidence-based recommendations for optimal ASP staffing are crucial for effective antimicrobial resistance mitigation.