Human resources for antimicrobial stewardship: a systematic review and exploratory meta-analysis

Area of Science:

• Healthcare Management
• Infectious Diseases
• Public Health

Background:

• Antimicrobial resistance (AMR) is a critical global health challenge.
• Antimicrobial stewardship programmes (ASPs) are essential for optimizing antimicrobial use.
• Multidisciplinary teams are emphasized in international guidelines for ASPs.

Purpose of the Study:

• To synthesize evidence on the organization and staffing of ASP functions and activities.
• To quantify the full-time equivalent (FTE) involvement of different professional groups in stewardship.
• To identify patterns in ASP staffing across various healthcare settings.

Main Methods:

• Systematic review following PRISMA guidelines.
• Searched multiple databases (Medline, Scopus, Embase, CINAHL, CABI) and grey literature.
• Included studies reporting stewardship functions, activities, or FTEs for ID physicians, pharmacists, nurses, microbiologists, and epidemiologists.

Main Results:

• Fifty studies were included, detailing stewardship functions and activities.
• Responsibilities were distributed across professional groups: physicians/pharmacists (prescribing), nurses (monitoring/education), microbiologists (diagnostics), epidemiologists (surveillance).
• Reported FTE involvement varied significantly by hospital size and context, with descriptive patterns suggesting more involvement in larger hospitals.

Conclusions:

• Existing evidence does not provide definitive staffing benchmarks for antimicrobial stewardship.
• Significant variability exists in how ASP functions are organized and resourced.
• Future research needs consistent reporting of stewardship activities, roles, and context for improved comparability.