Effectiveness of work-based educational interventions for antimicrobial stewardship: a systematic review.

Background: The pressing need for better antimicrobial stewardship (AMS) is invariably reliant on educational interventions in some form. Objectives: To evaluate the effectiveness of post-qualification educational interventions for AMS behaviour change among health professionals. Methods: Seven databases were searched for articles published between 2013 and 2024 for post-qualification educational interventions aimed at health professionals to improve AMS. Randomised controlled trials (RCTs) and quasi-experimental designs such as non-randomised trials, controlled and non-controlled before and after studies, and qualitative studies were considered eligible. The quality of studies was assessed using Cochrane Effective Practice and Organization of Care (EPOC) criteria for RCTs and interrupted time series designs, and the Mixed Methods Appraisal Tool (MMAT) for all other studies. Data were extracted, analysed for effectiveness, and synthesised narratively. Registration: PROSPERO international prospective register of systematic reviews (PROSPERO 2023 CRD42023447115). Results: Forty-six studies were included in the review, with six meeting the EPOC criteria. The remaining forty were assessed using the MMAT. The overall risk of bias for the six studies meeting the EPOC criteria was low, but risk of bias was high for studies assessed using the MMAT. Overall, there was some evidence that formal education alone was effective in this context, but only limited evidence about what type of educational intervention, for which profession, is most effective. Conclusions: Our review provided an in-depth examination of post-qualification AMS interventions. We found studies were heterogeneous and quality of evidence relatively poor. High quality studies focused on establishing key components of effective educational interventions are required.