Work

Strengthening antimicrobial stewardship through an international multicentre improvement programme of hospitals serving deprived populations

Year: 2026

Type: article

Abstract: Background: Antimicrobial stewardship (AMS) is essential to addressing antimicrobial resistance, but its implementation remains variable, particularly in settings with resource limitations. Hospitals serving deprived or underserved populations often work with limited diagnostic capacity, workforce pressures and variable digital infrastructure, which shape stewardship delivery. The Antimicrobial Stewardship Disparities Programme (ASDP) was established to strengthen stewardship capability in such settings and to support progress towards accreditation under the Global AMS Accreditation Scheme (GAMSAS). Methods: A mixed-methods evaluation was undertaken across six centres in Botswana, Kenya, Lebanon, Mexico, Pakistan and the USA. Centres completed baseline and end of programme self-assessments against 17 AMS, infection prevention and control (IPC) and laboratory standards mapped to 4 pillars (structures, guidance, education and surveillance). Programme documentation was analysed to identify themes, contextual influences and barriers. All work was delivered within existing resources. Results: Centres achieved improvements across AMS, IPC and laboratory standards, with consistent progress in surveillance. Governance was strengthened through clearer AMS committee structures, and guidance improved through prescribing tools embedded in practice. Education and laboratory standards showed limited change, reflecting workforce pressures, lack of protected time and constrained diagnostic capacity. Three centres achieved GAMSAS accreditation. Qualitative findings highlighted strategies to advance stewardship within structural constraints, including surveillance systems, training and locally adapted guidance. Conclusions: Local aims, supported by a standards framework and mentorship, enabled centres to strengthen stewardship capability within existing resources. Workforce capacity, diagnostic access and digital infrastructure remain key determinants. Structured assessment and shared learning support scalable AMS in underserved settings.

Source: JAC-Antimicrobial Resistance

DOI: 10.1093/jacamr/dlag241