Currently submitted to: JMIR Research Protocols
Date Submitted: Mar 27, 2026
Open Peer Review Period: Mar 27, 2026 - May 22, 2026
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Nurse-Led Antimicrobial Stewardship in Hospital and Primary Care Settings: Protocol for a Mixed-Methods Systematic Review and Meta-Analysis
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:
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
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
Citation
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