The role of digital tools and artificial intelligence in supporting antimicrobial stewardship: a systematic review

INTRODUCTION: Antimicrobial resistance is recognized by the WHO as one of the leading global public health challenges. Antimicrobial Stewardship Programmes (ASPs) aim to promote the rational and efficient use of antimicrobials, although their implementation faces various limitations. Digital tools and artificial intelligence (AI) emerge as strategies to improve the efficiency and outcomes of these programmes. OBJECTIVE: To analyse the role of digital tools and AI in hospital-based ASP interventions and their impact on clinical, microbiological and antimicrobial use indicators. MATERIAL AND METHODS: A systematic review was conducted following PRISMA methodology. A bibliographic search was performed in PubMed, Scopus and Cochrane Library (2014-25), as well as grey literature. Articles on hospitalized patients requiring antimicrobial treatment were included according to PICOS criteria. Risk of bias and methodological quality were assessed according to the type of study. Two independent researchers conducted the selection, evaluation and data extraction. A third researcher resolved discrepancies. RESULTS: Thirty-one studies met the inclusion criteria. The most commonly used tools were Clinical Decision Support Systems (58%), followed by alerts in electronic health records, machine learning models, telemedicine and mobile applications. Most studies showed improvements in therapeutic appropriateness and reduction in antibiotic consumption. However, the impact on clinical and microbiological indicators was heterogeneous and of low quality. CONCLUSION: Digital tools applied in ASPs improve prescription quality indicators and reduce antimicrobial consumption. Nevertheless, their impact on clinical and microbiological outcomes remains limited. Standardized indicators and robust methodological studies are needed to confirm their real impact on ASP outcomes. PROTOCOL REGISTRATION: This protocol has been registered in PROSPERO with the ID: CRD42024601221.