Real-world implementation and impact of interventional antimicrobial stewardship programmes in Asian hospital settings: an updated systematic review mapped to IDSA/SHEA recommendations, the WHO Bacterial Priority Pathogens List, and AWaRe antibiotic categories
In brief
Interventional stewardship programs reduce broad-spectrum antibiotic use in Asian hospitals
A systematic review of 32 Asian inpatient studies found that programs using preauthorization, audit-feedback, and education consistently lowered consumption of WHO Watch and some Reserve antibiotics, with cost savings and unchanged mortality. Resistance outcomes were reported less often and showed mixed effects, highlighting the need for better diagnostic stewardship and standardized reporting.
- Journal
- The Journal of hospital infection (Q1)
- Published
- 2 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Huifen Zhang, Bin Zhou, Yew Fong Lee, Jiancong Wang
- PMID
- 42685915
- DOI
- 10.1016/j.jhin.2026.08.021
Why clinicians should know about it
- Picked for Microbiology (medical) (paper of the day, 5 September 2026): Interventional antimicrobial stewardship in Asian hospitals
Abstract
Antimicrobial stewardship programmes are central to antimicrobial resistance control, but regional evidence from Asian hospitals remains heterogeneous. We aimed to update evidence on inpatient interventional ASP/AMS studies in Southeast and East Asia and to map intervention components, antibiotic-use outcomes, and resistance outcomes to IDSA/SHEA recommendations, WHO AWaRe categories, and the WHO Bacterial Priority Pathogens List. Medline via PubMed, Embase, and Scopus were searched for studies published from 20 June 2016 to 22 March 2026. Eligible studies were adult inpatient interventional ASP/AMS studies reporting antibiotic consumption, AMR incidence, mortality, or costs/expenditures. Two reviewers independently selected studies, extracted data, and assessed quality or risk of bias. Controlled and interrupted time-series designs were assessed using EPOC criteria; non-controlled before-after studies were assessed using ICROMS. Synthesis was descriptive because of heterogeneity. Thirty-two studies were included. Most were single-centre (29/32, 90.6%) and conducted in China (22/32, 68.8%) or Singapore (6/32, 18.8%). Preauthorization and/or prospective audit and feedback was the most common mapped IDSA/SHEA component (22 studies), followed by education (18 studies), shortest effective duration (13 studies), facility-specific guidelines (9 studies), and computerized clinical decision support (8 studies). Antibiotic-use and cost outcomes were consistently favourable, with AWaRe-classifiable reductions concentrated in Watch and selected Reserve antibiotics. Resistance outcomes were less consistently reported but included reductions in selected WHO critical- and high-priority phenotypes; mortality was generally unchanged. ASPs in Southeast and East Asia are increasingly multifaceted. This combined implementation and public-health mapping identifies progress and highlights gaps in diagnostic stewardship, special populations, and standardized outcome reporting.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.