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.
Huifen Zhang, Bin Zhou, Yew Fong Lee et al.
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In 30 seconds
This updated systematic review examined adult inpatient interventional antimicrobial stewardship studies in Southeast and East Asia, mapping programme components and outcomes to IDSA/SHEA recommendations, WHO AWaRe categories, and the WHO Bacterial Priority Pathogens List. It included 32 studies, most of them single-centre (29/32, 90.6%) and conducted in China (22/32, 68.8%). Across a heterogeneous evidence base, antibiotic-use and cost outcomes were consistently favourable, with reductions concentrated in Watch and selected Reserve antibiotics. Resistance findings were less consistent, while mortality was generally unchanged.
Key findings
- Preauthorization and/or prospective audit and feedback was the most common mapped intervention component, appearing in 22 studies.
- Antibiotic-use and cost outcomes were consistently favourable; AWaRe-classifiable reductions mainly involved Watch and selected Reserve antibiotics.
- Resistance outcomes were reported less consistently but included reductions in selected WHO critical- and high-priority phenotypes; mortality was generally unchanged.
- Most studies were single-centre (29/32, 90.6%); 22/32 (68.8%) were conducted in China.
Why it matters
The review brings together implementation and public-health perspectives on hospital stewardship in a region where the evidence is heterogeneous. Its findings suggest that commonly used interventions can accompany favourable antibiotic-use and cost outcomes, while less consistent resistance reporting and gaps in diagnostic stewardship, special populations, and standardized outcomes limit assessment of broader impact.
What to keep in mind
The evidence was heterogeneous and synthesized descriptively; most included studies were single-centre. Resistance outcomes were less consistently reported.