JMIR Publications

ABSTRACT

Background:

Antimicrobial resistance (AMR) poses a growing and serious threat to patient safety worldwide. Nurses, as the largest professional group in the global health workforce, play a central role in antimicrobial management. However, their contributions to antimicrobial stewardship (AMS) programmes remain poorly characterised and inconsistently measured. To date, no systematic review has combined a meta-analysis of the clinical effectiveness of nurse-led or nurse-involved AMS interventions with an implementation-focused synthesis to inform policy, practice, or future research. This gap is particularly relevant for the Gulf Cooperation Council and the Middle East and North Africa (GCC/MENA) healthcare systems, where the burden of AMR is high, and evidence of nursing contributions to AMS is limited.

Objective:

This protocol describes a convergent, parallel-streams mixed-methods systematic review to determine: (1) the effectiveness of nurse-led or nurse-involved antimicrobial stewardship (AMS) interventions on patient and antimicrobial outcomes in hospital and primary care settings globally; (2) the barriers and facilitators to implementing nurse-led AMS interventions or programmes; and (3) synthesis GCC/MENA evidence via sub-group analysis

Methods:

The review will follow the JBI convergent, parallel-streams mixed-methods methodology. Eleven databases will be searched from January 2000 to April 2026. The review will include primary research comprising: (1) quantitative studies (Stream 1), including randomised controlled trials, quasi-experimental studies, interrupted time series, and controlled before-and-after studies reporting clinical or process outcomes of nurse-led or nurse-involved AMS interventions. Where appropriate, meta-analysis will be conducted using a random-effects model. Outcomes will include antibiotic consumption, prescribing appropriateness, mortality, hospital length of stay, time to first antibiotic dose, and blood culture collection rates. (2) qualitative studies (Stream 2), which will be synthesised using thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR 2.0) to identify barriers and facilitators of implementation. Findings from both streams will be integrated using a convergent joint display. Eight pre-specified subgroup analyses are planned, including comparisons between GCC/MENA countries and the rest of the world, and between intensive care and general ward settings. The certainty of evidence for quantitative outcomes will be assessed using GRADE. The review is registered with PROSPERO (CRD420261341653).

Results:

The protocol was registered with PROSPERO. Database searches are scheduled to commence in April 2026. Full-text screening is expected to be completed by June 2026, with data extraction and synthesis anticipated by October 2026. The completed systematic review to be submitted for publication in January 2027.

Conclusions:

This review will provide the first meta-analytic synthesis of the clinical effectiveness of nurse-led AMS, alongside a structured implementation analysis using CFIR 2.0. The findings will inform antimicrobial stewardship programme design, nursing education, and health policy, with particular relevance for GCC/MENA healthcare systems. Clinical Trial: PROSPERO: CRD420261341653; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1341653