Antimicrobial stewardship in Ireland (2010–2021): a scoping review

In 2009, the Strategy for the Control of Antimicrobial Resistance in Ireland (SARI) Hospital Antimicrobial Stewardship (AMS) Working Group published guidance on antimicrobial stewardship in hospitals. These were the first guidelines outlining the rationale for AMS in Irish hospitals and healthcare institutions. The aim of this scoping review is to evaluate the progress of AMS implementation in Ireland and align the findings with the 2009 SARI Hospital AMS Working Group guidance recommendations. Systematic searches were conducted in four electronic databases (PubMed, CINAHL, Embase, Web of Science) and five targeted websites for grey literature. Titles and abstracts were screened independently by two reviewers and all authors reviewed full-text publications. Studies were mapped into at least one of four predefined recommendations, (A) Structure and Organisation of Antimicrobial Stewardship, (B) Roles and Responsibilities for Prescribers, (C) Antimicrobial Stewardship Interventions and (D) Recommendations for non-acute Residential Healthcare Institutions. These recommendations will be used as a framework for the outcome of interest in this scoping review. The search yielded 544 peer reviewed papers, of which 29 were included and 327 grey reports, of which 24 were included. Most articles (n=46) were mapped to categories A and C. Findings in category A highlight inadequate staffing and the need for greater investment in Information Technology (IT) to support AMS and infection prevention and control. Category C findings emphasise implementation challenges, including the need for hospital leadership to commit to improved availability of relevant resources, improving diagnostic capacity, and provision of education for prescribers, pharmacists, nurses, and patients. AMS implementation in Ireland has progressed over the past two decades, but significant challenges remain. Addressing resources including recruitment of staff and a defined budget, development of a structured national implementation plan with agreed annual targets, investing in IT and strengthening leadership commitment for all healthcare settings will be essential for future improvements.