Impact of antimicrobial stewardship on healthcare-associated infections and antibiotic prescriptions in African countries: Systematic review and meta-analysis

TY - JOUR

T1 - Impact of antimicrobial stewardship on healthcare-associated infections and antibiotic prescriptions in African countries

T2 - Systematic review and meta-analysis

AU - Shuayb, Sikiru

AU - Sixsmith, Judith

AU - Robinson Okoyeuche, Chika

N1 - Publisher Copyright: © The Author(s) 2025.

PY - 2026/1

Y1 - 2026/1

N2 - Background: An antimicrobial stewardship programme (AMS) aims to combat antimicrobial resistance and healthcare-associated infections (HCAIs). While studies in developed countries show AMS’s effectiveness in reducing AMR and HCAIs, its impact in African countries, given differing socioeconomics, remains unclear. Objectives: To review the impact of AMS on HCAIs, antibiotic prescriptions, cost of antimicrobial procurement, and compliance with diagnostic measures for detecting resistant HCAIs in African countries. Methods: Two reviewers (S.S. and U.C.) searched databases like CINAHL, Medline, and PubMed for studies on AMS interventions in African countries, focussing on their impact on healthcare-associated infections (HCAIs) and antibiotic prescriptions. We excluded studies on outpatients, children, or those not in English and conducted a meta-analysis using data collected from changes in HCAIs before and after intervention using a random-effects model. Results: The search identified 1153 studies, of which 14 were included in the review, while four eligible studies were included in the meta-analysis. Thirteen of the 14 studies were designed using pre- and post-study methods, and one study employed a case-control method. AMS interventions effectively reduce antibiotic consumption, the cost of antibiotic procurement, and improve diagnostic measures for the detection of resistant microorganisms. The forest plot suggested a 34% reduction in HCAIs. Conclusions: In Africa, AMS interventions, whether combined or single, reduce HCAIs and antibiotic prescriptions in healthcare settings. Surgical antibiotic prophylaxis lowers HCAIs in hospitals by one-third. However, findings are cautiously generalised due to the varied quality of studies and the limited number of African countries involved.

AB - Background: An antimicrobial stewardship programme (AMS) aims to combat antimicrobial resistance and healthcare-associated infections (HCAIs). While studies in developed countries show AMS’s effectiveness in reducing AMR and HCAIs, its impact in African countries, given differing socioeconomics, remains unclear. Objectives: To review the impact of AMS on HCAIs, antibiotic prescriptions, cost of antimicrobial procurement, and compliance with diagnostic measures for detecting resistant HCAIs in African countries. Methods: Two reviewers (S.S. and U.C.) searched databases like CINAHL, Medline, and PubMed for studies on AMS interventions in African countries, focussing on their impact on healthcare-associated infections (HCAIs) and antibiotic prescriptions. We excluded studies on outpatients, children, or those not in English and conducted a meta-analysis using data collected from changes in HCAIs before and after intervention using a random-effects model. Results: The search identified 1153 studies, of which 14 were included in the review, while four eligible studies were included in the meta-analysis. Thirteen of the 14 studies were designed using pre- and post-study methods, and one study employed a case-control method. AMS interventions effectively reduce antibiotic consumption, the cost of antibiotic procurement, and improve diagnostic measures for the detection of resistant microorganisms. The forest plot suggested a 34% reduction in HCAIs. Conclusions: In Africa, AMS interventions, whether combined or single, reduce HCAIs and antibiotic prescriptions in healthcare settings. Surgical antibiotic prophylaxis lowers HCAIs in hospitals by one-third. However, findings are cautiously generalised due to the varied quality of studies and the limited number of African countries involved.

KW - Antimicrobial stewardship

KW - african countries

KW - antibiotic prescriptions

KW - healthcare-associated infections

KW - nosocomial infections

KW - systematic review and meta-analysis

UR - https://www.scopus.com/pages/publications/105025928908

U2 - 10.1177/17571774251377205

DO - 10.1177/17571774251377205

M3 - Review article

SN - 1757-1774

VL - 27

SP - 3

EP - 16

JO - Journal of Infection Prevention

JF - Journal of Infection Prevention

IS - 1

ER -