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Mapping hospital antimicrobial stewardship programmes in the Gulf Cooperation Council states against international standards: a systematic review.

Hashad, N.; Perumal, D.; Stewart, D.; Tonna, A.P.


D. Perumal

D. Stewart


Background: While there is evidence of implementation of antimicrobial stewardship programmes (ASP) in the Gulf Cooperation Council (GCC) States, there has been limited benchmarking and mapping to international standards and frameworks. Aim: To critically appraise and synthesise the evidence of ASP implementation in GCC hospitals while comparing to the framework of the Centers for Disease Control and Prevention (CDC) and identifying key facilitators and barriers. Methods: A systematic review protocol was developed based on Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols (PRISMA-P) guidelines. Five electronic databases were searched for studies published in English from 2010 onwards. Study selection, quality assessment and data extraction were independently performed by two reviewers. A narrative synthesis was conducted with antimicrobial stewardship programmes interventions mapped to CDC core elements. Findings: Seventeen studies were identified, mostly from Saudi Arabia (n=11). Mapping to the CDC framework identified key areas of strengths and weaknesses in reporting implementation. Studies more commonly reported core elements of pharmacy expertise, selected aspects of implementation actions, tracking, antibiotic use and resistance, and education. Little emphasis was placed on the reporting of leadership and accountability. Key implementation facilitators were physician and organisation support, information systems and education with barriers being dedicated staff, workload and funding. Conclusion: There is a need to enhance the reporting of ASP implementation in GCC hospitals. The CDC framework should be used as a guide during ASP intervention development, implementation and reporting. Action is required to identify facilitators and overcome barriers, where possible.


HASHAD, N., PERUMAL, D., STEWART, D. and TONNA, A. 2020. Mapping hospital antimicrobial stewardship programs in the Gulf Cooperation Council states against international standards: a systematic review. Journal of hospital infection [online], 106(3), pages 404-418. Available from:

Journal Article Type Article
Acceptance Date Sep 1, 2020
Online Publication Date Sep 8, 2020
Publication Date Nov 30, 2020
Deposit Date Sep 11, 2020
Publicly Available Date Sep 9, 2021
Journal Journal of hospital infection
Print ISSN 0195-6701
Electronic ISSN 1532-2939
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 106
Issue 3
Pages 404-418
Keywords Antimicrobial; Stewardship; Gulf Cooperation Council; Mapping; Centers for disease control and prevention; Systematic review
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