ArticleNaunyn-Schmiedeberg's archives of pharmacology2026
Multilevel barriers to antimicrobial stewardship in tertiary care hospitals: A comparative systematic scoping review of high-income versus low-/middle-income countries evidence mapped by study design and healthcare professionals.
Article in Naunyn-Schmiedeberg's archives of pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Antibiotic Resistance and the Return to a Pre-Antibiotic Era: A Critical Narrative Review of a Global Catastrophe.Biomedicines · 2026Review
- Antimicrobial stewardship in hospitals: effective and indispensable, yet structurally fragile.Frontiers in public health · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Antimicrobial stewardship (AMS) programmes are central to tackling antimicrobial resistance. Comparative evidence on how barriers differ between high-income countries (HICs) and low-/middle-income countries (LMICs) in tertiary care hospitals is limited. The review aims to identify and compare multilevel barriers to implementing AMS programmes in tertiary care hospitals in HICs and LMICs. We conducted a systematic scoping review following PRISMA-ScR and Joanna Briggs Institute guidance. PubMed and Web of Science were searched for English-language primary studies from January 2015 to November 2025. Studies were considered eligible if they examined barriers to implementing AMS in adult inpatient services in tertiary care hospitals. Using a framework-based thematic approach, barriers were grouped into eight themes and mapped to individual, team, organizational, and system levels. Out of 2311 records, 57 studies met inclusion criteria (23 = HICs, 34 = LMICs). Knowledge, education, and confidence gaps were the most frequent barrier theme in both groups, reported in about three-quarters of studies. Staffing and resource constraints and organisational/governance barriers were also highly prevalent, particularly in LMIC hospitals. Workflow and documentation problems and data-system limitations were more prominent in HIC studies, whereas structural health system constraints were more prominent in LMICs. Qualitative and mixed-methods studies identified a broader range of barriers than surveys or observational designs. AMS implementation in tertiary hospitals is constrained by overlapping multilevel barriers that are broadly similar across income groups but differ in emphasis. Tailored strategies that jointly strengthen workforce capacity, infrastructure and governance are needed, with particular attention to system-level constraints in LMICs and workflow and data challenges in HICs.
Indexed as
Identifiers
42045662What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.