Global impact of antimicrobial stewardship programs in Healthcare: An umbrella review of effectiveness, cost-efficiency, and implementation strategies

Background

Antimicrobial Stewardship Programs (ASPs) are vital in mitigating global threat of antimicrobial resistance (AMR) by optimizing antibiotic use and improving patient outcomes. Despite available evidence from high-income countries, challenges remain in low- and middle-income countries (LMIC) due to resource constraints and heterogeneous implementation. This umbrella review synthesizes evidence from systematic reviews to assess the effectiveness, cost-effectiveness, and implementation barriers and facilitators of ASPs across diverse healthcare settings.

Methods

Following PRIOR guidelines and PROSPERO registration (ID: CRD42024541821), we conducted comprehensive search of PubMed, Scopus, Cochrane Library, Epistemonikos, Google Scholar, and ScienceDirect up to July 2024. Data were extracted using standardized form and methodological quality of reviews was assessed with AMSTAR-2 tool. Given heterogeneity in study designs, outcomes, and ASP interventions, narrative synthesis was employed.

Results

The included 55 reviews demonstrated that ASPs consistently reduce antibiotic consumption—achieving reductions up to 91 %—and improve adherence to prescribing guidelines. Significant declines in resistance rates for key pathogens, such as MRSA and ESBL-producing organisms, were reported. Although effects on mortality and hospital length of stay were variable, most studies confirmed substantial cost-savings (up to 82 % reduction in antibiotic expenditures). Implementation barriers primarily included limited resources, insufficient data infrastructure, and prescriber resistance, while strong organizational support and multidisciplinary collaboration emerged as key facilitators.

Conclusion

ASPs are both clinically effective and economically advantageous in diverse healthcare settings. Tailored strategies that address local barriers and leverage existing infrastructure are essential for sustainable implementation. Future research should focus on standardized evaluation methods and long-term impacts to further optimize ASP adoption globally.