Impact of Pharmacist-Involved Antimicrobial Stewardship Interventions on Clinical and Process Outcomes in Multidrug-Resistant Organism Infections: A Systematic Review and Meta-Analysis.
- 1College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar.
- 2QU Health, Qatar University, Doha P.O. Box 2713, Qatar.
Abstract
Background/objectives
Antimicrobial resistance (AMR) is a major global health threat, and multidrug-resistant organisms (MDROs) are associated with worse outcomes than susceptible infections. Pharmacists are central to antimicrobial stewardship (AMS), yet their impact in confirmed MDRO infections is unclear. We evaluated pharmacist-involved AMS on clinical and process outcomes in MDRO infections and quantified pooled effects on clinical outcomes.Methods
Following PRISMA 2020, seven databases were searched (inception-December 2025) for pharmacist-involved AMS studies in patients with confirmed MDRO infections (Tier A) or in mixed populations from which MDRO-specific outcomes were extractable (Tier B), classified into Tier A, B, or C by outcome extractability. Random-effects meta-analyses were performed a priori for outcomes with ≥2 studies, with fixed-effect sensitivity and GRADE ratings.Results
Forty-nine studies were included (7 Tier A, 6 Tier B, 36 Tier C); quantitative synthesis was restricted to the 13 Tier A/B studies with MDRO-specific outcome data, and certainty of evidence was very low for all five pooled outcomes. Pharmacist involvement consistently improved process outcomes (time to therapy, de-escalation, antimicrobial consumption) and reduced mortality and readmissions in several subgroups. Pooled random effects RRs (95% CI) were: 30-day mortality, 0.64 (0.41-1.00; I² = 28%, non-significant); in-hospital mortality, 0.72 (0.57-0.92; I² = 6%, significant); 30-day readmission, 0.50 (0.31-0.79; I² = 0%, significant); recurrent infection, 0.51 (0.25-1.04); and acute kidney injury, 1.01 (0.54-1.87; both non-significant, I² = 0%).Conclusions
Multicomponent AMS interventions involving pharmacists were consistently associated with improved stewardship processes and significant reductions in in-hospital mortality and 30-day readmission, though evidence certainty remained very low. Larger, prospective studies with harmonized outcome definitions are needed to confirm the clinical benefit's magnitude.
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BibTeX
@article{nasr2026impact,
title = {{Impact of Pharmacist-Involved Antimicrobial Stewardship Interventions on Clinical and Process Outcomes in Multidrug-Resistant Organism Infections: A Systematic Review and Meta-Analysis.}},
author = {Ziad G Nasr and Alaa Sharafeldin and Mouda Hamdan and Zainab Al-Muhsin and Dima Baker and Dina Abushanab},
journal = {Antibiotics (Basel, Switzerland)},
year = {2026},
month = sep,
doi = {10.3390/antibiotics15100955},
url = {https://europepmc.org/article/MED/42938696},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of Pharmacist-Involved Antimicrobial Stewardship Interventions on Clinical and Process Outcomes in Multidrug-Resistant Organism Infections: A Systematic Review and Meta-Analysis.
AU - Ziad G Nasr
AU - Alaa Sharafeldin
AU - Mouda Hamdan
AU - Zainab Al-Muhsin
AU - Dima Baker
AU - Dina Abushanab
PY - 2026
DA - 2026/09/25
JO - Antibiotics (Basel, Switzerland)
DO - 10.3390/antibiotics15100955
UR - https://europepmc.org/article/MED/42938696
AB - Background/objectives Antimicrobial resistance (AMR) is a major global health threat, and multidrug-resistant organisms (MDROs) are associated with worse outcomes than susceptible infections. Pharmacists are central to antimicrobial stewardship (AMS), yet their impact in confirmed MDRO infections is unclear. We evaluated pharmacist-involved AMS on clinical and process outcomes in MDRO infections and quantified pooled effects on clinical outcomes.Methods Following PRISMA 2020, seven databases were searched (inception-December 2025) for pharmacist-involved AMS studies in patients with confirmed MDRO infections (Tier A) or in mixed populations from which MDRO-specific outcomes were extractable (Tier B), classified into Tier A, B, or C by outcome extractability. Random-effects meta-analyses were performed a priori for outcomes with ≥2 studies, with fixed-effect sensitivity and GRADE ratings.Results Forty-nine studies were included (7 Tier A, 6 Tier B, 36 Tier C); quantitative synthesis was restricted to the 13 Tier A/B studies with MDRO-specific outcome data, and certainty of evidence was very low for all five pooled outcomes. Pharmacist involvement consistently improved process outcomes (time to therapy, de-escalation, antimicrobial consumption) and reduced mortality and readmissions in several subgroups. Pooled random effects RRs (95% CI) were: 30-day mortality, 0.64 (0.41-1.00; I² = 28%, non-significant); in-hospital mortality, 0.72 (0.57-0.92; I² = 6%, significant); 30-day readmission, 0.50 (0.31-0.79; I² = 0%, significant); recurrent infection, 0.51 (0.25-1.04); and acute kidney injury, 1.01 (0.54-1.87; both non-significant, I² = 0%).Conclusions Multicomponent AMS interventions involving pharmacists were consistently associated with improved stewardship processes and significant reductions in in-hospital mortality and 30-day readmission, though evidence certainty remained very low. Larger, prospective studies with harmonized outcome definitions are needed to confirm the clinical benefit's magnitude.
SN - 2079-6382
ER -