Vol. 2, Issue 1, Part A (2025)

Background: The global escalation of antimicrobial resistance (antimicrobial resistance (AMR)) poses a significant threat to patient safety and healthcare sustainability. Hospital-based antimicrobial stewardship programs (Antimicrobial Stewardship Programs (ASPs)) have emerged as key interventions to optimize antimicrobial use, but their success largely depends on multidisciplinary participation. This study aimed to evaluate the impact of hospital pharmacist-led Antimicrobial Stewardship Program (ASP) interventions on antimicrobial utilization and the incidence of multidrug-resistant (MDR) infections in a tertiary-care hospital.
Methods: A prospective quasi-experimental study was conducted over 12 months in a 500-bed tertiary hospital. Adult inpatients receiving systemic antimicrobials were included, with data divided into pre-intervention (control) and post-intervention (pharmacist-led Antimicrobial Stewardship Program (ASP)) phases. The intervention consisted of pharmacist-driven activities including prospective audit with feedback, dose optimization, intravenous-to-oral switch facilitation, and de-escalation recommendations. Data were analyzed using descriptive and inferential statistics, with antimicrobial use measured as Defined Daily Doses (DDD) per 1, 000 patient-days and MDR infection rates compared across study phases.
Results: A total of 1, 240 patients were enrolled (630 control; 610 intervention). Overall antimicrobial consumption declined from 640 to 495 DDD/1, 000 patient-days (22.7% reduction; p = 0.01), with significant decreases in carbapenem and cephalosporin use. Prescription appropriateness improved markedly from 62.4% to 81.6% (p < 0.001), and the rate of de-escalation and IV-to-oral switch interventions also increased significantly. The incidence of MDR infections fell from 10.4 to 7.2 per 1, 000 patient-days (relative reduction 30.8%; p = 0.004), with the largest decreases observed for ESBL-producing Enterobacterales and carbapenem-resistant Klebsiella pneumoniae. Mortality and mean hospital stay remained stable, and antibiotic expenditure declined by 18.5%.
Conclusion: The integration of pharmacists as core members of Antimicrobial Stewardship Programs (ASPs) significantly improved antibiotic stewardship performance, reduced inappropriate antimicrobial use, and achieved meaningful reductions in MDR infection rates without compromising patient outcomes. This study reinforces the necessity of pharmacist-led stewardship as a sustainable and cost-effective strategy for antimicrobial resistance (AMR) containment in hospital environments. Institutional support, interprofessional collaboration, and continuous monitoring are essential to sustain these gains and strengthen global stewardship efforts.