Antimicrobial stewardship interventions in adults with hospital-acquired pneumonia: a systematic review and meta-analysis
Ablakimova N. Rachina S. Strelkova D. Suvorov A. Smagulova G.
March 2026W.B. Saunders Ltd
Journal of Hospital Infection
2026#169176 - 192 pp.
Background: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) represent the most severe healthcare-associated infections (HAIs), characterized by high morbidity, mortality and antimicrobial resistance rates. Aim: The aim of this study was to systematically assess the impact of antimicrobial stewardship and diagnostic interventions on clinical, microbiological and process outcomes in adult patients with HAP/VAP. Methods: A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (International Prospective Register of Systematic Reviews registration number: CRD42023492494). PubMed, Scopus and Web of Science databases were searched for studies published from 2000 to May 2025. Eligible designs included randomized trials, quasi-experimental and before-and-after studies involving adults with HAP or VAP. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were estimated using random-effect models in R (meta package). Findings: Nineteen studies were included, of which 11 were meta-analysed. Antimicrobial stewardship programme (ASP) interventions significantly reduced the duration of antibiotic therapy (SMD = –1.02; 95% confidence interval [CI]: –1.76 to –0.28; P = 0.007). A significant improvement was also observed for protocol adherence (OR = 5.91; 95% CI: 1.26–27.67; P = 0.024). No statistically significant differences were found for hospital mortality (OR = 0.73; 95% CI: 0.51–1.05; P = 0.088), 30-day in-hospital mortality (OR = 1.13; 95% CI: 0.73–1.76; P = 0.58), length of intensive care unit (ICU) stay or ventilator-free days. Heterogeneity was high across designs. Conclusion: Stewardship interventions for HAP/VAP safely shorten antibiotic duration and improve adherence to clinical protocols without compromising patient safety. To achieve more meaningful clinical impact, future ASP models should integrate diagnostics, pharmacokinetic/pharmacodynamic-guided dosing and ventilator-care bundles within multi-disciplinary ICU frameworks.
Antimicrobial stewardship , Attitudes , Health knowledge , Healthcare-associated infections , Hospital-acquired pneumonia , Practice , Ventilator-associated pneumonia
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Department of Pharmacology, Clinical Pharmacology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
Department of Hospital Pharmacy, Aktobe Regional Perinatal Center, Aktobe, Kazakhstan
Hospital Therapy Department No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
Department of Pharmacology
Department of Hospital Pharmacy
Hospital Therapy Department No. 2
World-Class Research Center “Digital Biodesign and Personalized Healthcare”
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