ReviewEClinicalMedicine2025
The latent system factors that influence antimicrobial use and governance in healthcare: a scoping review of high-income health systems.
Review in EClinicalMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Inappropriate antimicrobial use accelerates antimicrobial resistance (AMR), creating tensions between antimicrobial stewardship and timely treatment. Despite global calls to action, gaps between recommendations and practice persist, largely due to system factors shaping clinical work. This review examines how systems approaches have been applied to the use and governance of antimicrobials. Methods: This scoping review followed PRISMA-ScR. Eligible sources included empirical studies, reviews, protocols, theses/dissertations, and improvement projects across healthcare settings in high-income countries. Studies required explicit use of systems approaches. EMBASE, MEDLINE, and CINAHL were searched in November 2024. Grey literature was added in February 2025. Search was updated in July 2025. Three researchers extracted data on study characteristics, systems approaches, and organisational implications. Review was preregistered (https://osf.io/p3xsf). Findings: 25 articles were ultimately included. Seven focused on acute care and 18 leveraged interviews. Among studies involving participants (n = 18), 12 involved only frontline level participants, four involved participants from different organisational levels with a focus on frontline settings, and two focused on management settings. Implications of the use of systems approaches were identified across three organisational levels: micro (patient care), meso (management), and macro (leadership). Interpretation: This is the first review to map the implications of systems approaches for AMR at different organisational levels. Findings suggest gaps in the application of systems approaches at levels most responsible for strategic decisions and implementation. Given recent criticism about safety management and calls for strong AMS leadership, this gap represents a missed improvement opportunity. Future research should explore how alignment toward AMS is impacted due to system factors within and between organisational levels. Funding: Supported by INEOS Oxbridge Initiative on Antimicrobial Resistance (Project number E4R00010).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.