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Antibiotics
Special Issues
Antimicrobial Stewardship—from Projects to Standard of Care
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Antimicrobial Stewardship—from Projects to Standard of Care

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: 30 April 2026 | Viewed by 4608

Special Issue Editors

Dr. Gesche Först

E-Mail Website
Guest Editor
1. Clinical Pharmacy, Institute of Pharmaceutical Sciences, Faculty of Chemistry and Pharmacy, Albert-Ludwigs-University, 79085 Freiburg, Germany
2. Division of Infectious Diseases, Department of Medicine II, University Hospital and Medical Centre, and Faculty of Medicine, Albert-Ludwigs-University, 79106 Freiburg, Germany
Interests: antimicrobial stewardship; antimicrobial use; health services research; digitalization of healthcare; medication safety; quality assurance
Dr. Franky Buyle

E-Mail Website
Guest Editor
Department of Pharmacy, Ghent University Hospital, 9000 Ghent, Belgium
Interests: antimicrobial stewardship; OPAT; pharmaceutical service

Special Issue Information

Dear Colleagues,

Antimicrobial stewardship (AMS) remains central for combating antimicrobial resistance ensuring the safe use of antimicrobials. AMS has been shown to be effective and safe; however, its implementation varies widely. Despite successful local and national guidelines, programs and projects, achieving universal integration into standard care remains a challenge. This Special Issue aims to elucidate the gap between current AMS practices and AMS recommendations in different settings. We invite original research, reviews and case reports that address the following topics:

  • Extent of the implementation of AMS recommendations;
  • Feasibility of special AMS measures and programs;
  • Results of AMS interventions;
  • Sustainability of AMS projects;
  • Risk factors, barriers and facilitators of AMS interventions and programs;
  • Quality assurance in AMS;
  • Use and efficacy of digital AMS tools;
  • Innovative AMS projects.

This Special Issue aims to foster a broad dialogue on the evolution of AMS from isolated successes to standard of care, providing insights that can inform policy, practice and future research directions.

Dr. Gesche Först
Dr. Franky Buyle
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antimicrobial stewardship
  • antimicrobial use
  • antibiotics
  • implementation
  • efficacy
  • quality
  • antimicrobial prescribing

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Published Papers (4 papers)

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Research

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21 pages, 654 KB  
Article
Establishing Priority Pediatric Antimicrobial Stewardship Interventions in the US: Findings from a Delphi Consensus Study
by Harry Obeng, Emmanuel Tetteh, Sara Malone, Lauren Walsh, Tyler Walsh, Fernando J. Bula-Rudas, Ritu Banerjee, Adam W. Brothers, Joshua C. Herigon, Katie Namtu, Scott Weissman, Daniel Riggsbee, Jared Olson, Debra Lynn Palazzi, Ann Wirtz, Matthew Sattler, Jessica Tansmore, Brittany A. Rodriguez, Monica Abdelnour, Joshua R. Watson, Alison C. Tribble, Jessica Gillon, Mari Nakamura, Sarah Jones, Jason G. Newland and Virginia R. McKayadd Show full author list remove Hide full author list
Antibiotics 2025, 14(10), 1011; https://doi.org/10.3390/antibiotics14101011 - 11 Oct 2025
Cited by 1 | Viewed by 1049
Abstract
Background/Objectives: Antimicrobial resistance (AMR) is a major global health threat, with children at higher risk due to developmental differences in drug metabolism, limited treatment options and inappropriate antibiotic use. Pediatric antimicrobial stewardship programs (ASPs) face implementation challenges, often relying on adult-based guidelines and [...] Read more.
Background/Objectives: Antimicrobial resistance (AMR) is a major global health threat, with children at higher risk due to developmental differences in drug metabolism, limited treatment options and inappropriate antibiotic use. Pediatric antimicrobial stewardship programs (ASPs) face implementation challenges, often relying on adult-based guidelines and limited pediatric-specific evidence. This study aimed to identify and prioritize the most critical areas for pediatric ASP intervention development through a structured, multi-round Delphi consensus process with experts in antimicrobial stewardship and infectious diseases. Method: A four-round modified Delphi process was conducted to identify and prioritize key pediatric ASP interventions. Experts in antimicrobial stewardship and infectious diseases were recruited through an existing clinical trial. Using an iterative survey and in-person discussions, experts provided input on priority areas, which were thematically grouped and refined across rounds. Structured feedback supported real-time refinement and consensus-building. Results: Twenty experts participated in the process, generating 25 priority items in Round 1 through open-ended responses. These were narrowed to seven key priorities through structured voting and discussion. The final items were clustered into three intersecting themes: Care Settings, Prescriptions, and Strategies. Care Settings focused on high-impact areas such as outpatient clinics and intensive care units, where misuse is common and/or care is complex. The prescriptions theme prioritized shorter durations and narrow-spectrum agents. The strategy theme highlighted the need for outcome-based metrics, improved diagnostic stewardship, and routine tracking of patient outcomes to guide and assess stewardship efforts. Conclusions: This expert consensus identified key priorities for pediatric ASPs, providing a foundation for future interventions. Findings can be used to inform policy and practice, improving the appropriate use of antimicrobials in pediatrics and combating AMR. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship—from Projects to Standard of Care)
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15 pages, 626 KB  
Article
Outpatient Parenteral Antimicrobial Therapy in a Tertiary Hospital in France: A Description of Service Models and Costs
by Espérie Burnet, Alicia Le Bras, Guillaume Roucoux, Christian Dupont, Etienne Canouï, Clément Leclaire, Jérémie Zerbit, Pierre Régis Burgel, Clémence Martin, Isabelle Durand-Zaleski and Martin Duracinsky
Antibiotics 2025, 14(10), 971; https://doi.org/10.3390/antibiotics14100971 - 26 Sep 2025
Viewed by 849
Abstract
Background/Objectives: Outpatient parenteral antimicrobial therapy (OPAT) has been implemented throughout the world for the treatment of most infections. Published studies have focused on OPAT delivery, with limited data on coordination and monitoring practices. Methods: A mixed methods study, using an exploratory sequential design, [...] Read more.
Background/Objectives: Outpatient parenteral antimicrobial therapy (OPAT) has been implemented throughout the world for the treatment of most infections. Published studies have focused on OPAT delivery, with limited data on coordination and monitoring practices. Methods: A mixed methods study, using an exploratory sequential design, was conducted at a tertiary hospital in Paris, France. Ten semi-structured interviews were conducted with prescribing physicians and professionals involved in OPAT coordination and monitoring. A general inductive approach was used to analyze verbatim data and build a framework for OPAT model characterization. Cost estimates, using a standardized scenario, were applied to each model. Results: Five OPAT coordination and monitoring models were identified. All OPATs were administered by visiting nurses in the patient’s home. Referral to an infectious disease physician was not systematic, and three models, with 3 to 50 OPAT episodes/year each, outsourced hospital-to-home coordination and monitoring to external medical service and device providers. Only one OPAT model, with 450 OPATs annually, included a nurse specialist within the unit to coordinate and monitor treatment. Clinically and/or socially vulnerable patients received OPAT through hospital at home services, which reported 30 OPATs/year. Under the standardized clinical scenario applied to each OPAT model, weekly costs ranged from EUR 1445 to EUR 2308. Conclusions: The diversity of OPAT coordination and monitoring practices identified within a single hospital suggests that similar trends may be observed in other settings, in France and elsewhere. Identifying the most cost-effective OPAT service model could guide stakeholders and facilitate the implementation of best practice recommendations in line with antimicrobial stewardship principles. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship—from Projects to Standard of Care)
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14 pages, 281 KB  
Article
Optimising Regimen of Co-Amoxiclav (ORCA)—The Safety and Efficacy of Intravenous Co-Amoxiclav at Higher Dosing Frequency in Patients with Diabetic Foot Infection
by Jun Jie Tan, Peijun Yvonne Zhou, Jia Le Lim, Fang Liu and Lay Hoon Andrea Kwa
Antibiotics 2025, 14(8), 758; https://doi.org/10.3390/antibiotics14080758 - 28 Jul 2025
Viewed by 1256
Abstract
Background: With increasing pharmacokinetic evidence suggesting the inadequacy of conventional dose intravenous co-amoxiclav (IVCA) 1.2 g Q8H in targeting Enterobacterales, our institution antibiotic guidelines optimised dosing recommendations for diabetic foot infection (DFI) management to 1.2 g Q6H in August 2023. In [...] Read more.
Background: With increasing pharmacokinetic evidence suggesting the inadequacy of conventional dose intravenous co-amoxiclav (IVCA) 1.2 g Q8H in targeting Enterobacterales, our institution antibiotic guidelines optimised dosing recommendations for diabetic foot infection (DFI) management to 1.2 g Q6H in August 2023. In this study, we aim to evaluate the efficacy and safety of the optimised dose IVCA in DFI treatment. Methods: In this single-centre cohort study, patients ≥ 21 years with DFI, creatinine clearance ≥ 50 mL/min, and weight > 50 kg, who were prescribed IVCA 1.2 g Q8H (standard group (SG)), were compared with those prescribed IVCA 1.2 g Q6H (optimised group (OG)). Patients who were pregnant, immunocompromised, had nosocomial exposure in last 3 months, or received < 72 h of IVCA were excluded. The primary efficacy outcome was clinical deterioration at end of IVCA monotherapy. The secondary efficacy outcomes include 30-day readmission and mortality, empiric escalation of antibiotics, lower limb amputation, and length of hospitalisation. The safety outcomes include hepatotoxicity, renal toxicity, and diarrhoea. Results: There were 189 patients (94 in SG; 95 in OG) included. Patients in SG (31.9%) were twice as likely to experience clinical deterioration compared to OG (16.8%) (odds ratio: 2.31, 95% confidence interval: 1.16–4.62, p < 0.05). There were statistically more patients who had 30-day all-cause mortality in SG (5.3%) compared to OG (0%) (p < 0.05). Furthermore, 30-day readmission due to DFI in SG (26.6%) was higher compared to OG (11.6%) (p < 0.05). Empiric escalation of IV antibiotics was required for 14.9% patients in SG and 6.3% patients in OG (p = 0.06). There was no statistical difference for lower limb amputation (p = 0.72), length of hospitalisation (p = 0.13), and the occurrence of safety outcomes in both groups. Conclusions: This study suggests IVCA 1.2 g Q6H is associated with the decreased likelihood of clinical deterioration and is likely as safe as IVCA 1.2 g Q8H. The optimised dose of IVCA may help reduce the use of broad-spectrum antibiotics due to clinical deterioration. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship—from Projects to Standard of Care)
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Review

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14 pages, 432 KB  
Review
Changing Antibiotic Prescribing Cultures: A Comprehensive Review of Social Factors in Outpatient Antimicrobial Stewardship and Lessons Learned from the Local Initiative AnTiB
by Janina Soler Wenglein, Reinhard Bornemann, Johannes Hartmann, Markus Hufnagel and Roland Tillmann
Antibiotics 2025, 14(11), 1068; https://doi.org/10.3390/antibiotics14111068 - 24 Oct 2025
Viewed by 1019
Abstract
Antimicrobial resistance (AMR) constitutes a major global health challenge, driven significantly by inappropriate antibiotic use in human medicine. Despite the existence of evidence-based guidelines, variability in antibiotic prescribing persists, influenced by psychosocial factors, diagnostic uncertainty, patient expectations, and local prescribing cultures. Outpatient care, [...] Read more.
Antimicrobial resistance (AMR) constitutes a major global health challenge, driven significantly by inappropriate antibiotic use in human medicine. Despite the existence of evidence-based guidelines, variability in antibiotic prescribing persists, influenced by psychosocial factors, diagnostic uncertainty, patient expectations, and local prescribing cultures. Outpatient care, the setting in which most antibiotics are prescribed, is particularly affected by such challenges. Traditional top-down interventions, such as national guidelines, often fail to achieve sustained behavioral change among prescribers. In this comprehensive review, we provide an overview of the psychological and behavioral factors influencing antimicrobial stewardship (AMS) implementation, as well as describe a bottom-up project working to meet these challenges: the “Antibiotic Therapy in Bielefeld” (AnTiB) initiative. AnTiB employs a cross-sectoral strategy aimed at developing rational prescribing culture by means of locally developed consensus guidelines, interdisciplinary collaboration, and regularly held trainings. By addressing both the organizational and psychological aspects of prescribing practices, AnTiB has facilitated a harmonization of antibiotic use across specialties and care interfaces at the local level. The initiative’s success has led to its expansion within Germany, including through the creation of the AMS-Network Westphalia Lippe and the development of AnTiB-based national pediatric recommendations. These projects are all grounded in social structures designed to strengthen the long-term establishment of AMS measures. Our efforts underscore the importance of considering local social norms, professional network, and real-world practice conditions in AMS interventions. Integrating behavioral and social science approaches into outpatient antimicrobial stewardship—exemplified by the practitioner-led AnTiB model—improves acceptability and alignment with stewardship principles; wider adoption will require local adaptation, routine outpatient resistance surveillance, structured evaluation, and sustainable support. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship—from Projects to Standard of Care)
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