Antimicrobial Resistance Patterns in Intensive Care Units and the Effectiveness of Targeted Antibiotic Stewardship Programs: A Systematic Review

Abstract

organisms in these settings complicates infection management and may contribute to increased morbidity, mortality, healthcare costs, and length of hospital stay. Antibiotic stewardship programs (ASPs) have been increasingly implemented to optimize antimicrobial use and reduce the development and spread of resistance.

Objective: This systematic review aims to synthesize the available evidence on antimicrobial resistance patterns in intensive care units, examine variations across geographic and clinical settings, identify the main components of targeted antibiotic stewardship programs, and evaluate their effectiveness in reducing antimicrobial resistance and antibiotic consumption and improving clinical outcomes.

Methods: This systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search will be performed in PubMed, Scopus, Web of Science, and the Cochrane Library. Eligible studies will include randomized controlled trials, observational studies, cohort studies, and quasi-experimental studies involving patients admitted to intensive care units and reporting antimicrobial resistance patterns and/or the effects of antibiotic stewardship interventions. Two independent reviewers will perform study selection, data extraction, and risk-of-bias assessment using appropriate methodological appraisal tools. A narrative synthesis will be conducted, and a meta-analysis will be performed when sufficient clinical and methodological homogeneity exists among the included studies.

Expected Results: The review is expected to identify the predominant multidrug-resistant pathogens encountered in ICUs, including Acinetobacter species, Pseudomonas aeruginosa, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus (MRSA), and to characterize regional variations in resistance patterns. It will also evaluate the effects of targeted stewardship interventions, including antibiotic de-escalation, prospective audit and feedback, formulary restriction, and guideline-based prescribing, on antibiotic consumption, antimicrobial resistance, and patient outcomes.

Conclusion: This systematic review will provide a comprehensive synthesis of current evidence regarding antimicrobial resistance patterns and targeted antibiotic stewardship interventions in intensive care units. The findings are expected to support evidence-based clinical practice, inform institutional antimicrobial stewardship policies, and contribute to the development of effective strategies for reducing antimicrobial resistance while optimizing patient outcomes.