Human resources for antimicrobial stewardship: a systematic review and exploratory meta-analysis.

Background: Antimicrobial resistance (AMR) is a major global health threat, and antimicrobial stewardship programmes (ASPs) are a cornerstone strategy to optimise antimicrobial use. International guidelines emphasise multidisciplinary teams; however, evidence describing how stewardship functions are organised, and quantified across professional groups remains fragmented, particularly outside high-income settings. This review synthesised evidence on stewardship functions, activities, and reported full-time equivalent (FTE) staffing patterns. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Medline, Scopus, Embase, CINAHL, CABI, and grey-literature sources were searched to November 2025. Studies reporting stewardship functions, activities, or FTE involvement among infectious disease (ID) physicians, ID clinical pharmacists, infection control nurses (ICNs), clinical microbiologists, and hospital epidemiologists were included. Narrative synthesis mapped functions across professional groups. Where data permitted, exploratory post-hoc quantitative synthesis of reported FTEs by hospital bed capacity was conducted using random-effects models. Study quality and bias were assessed. Results: Fifty studies met the inclusion criteria: 44 described stewardship functions and activities, and seven reported FTE data. Responsibilities were distributed across professional groups: ID physicians and ID clinical pharmacists were mainly involved in prescribing oversight and optimisation, ICNs in monitoring and education, clinical microbiologists in diagnostic stewardship, and hospital epidemiologists in surveillance and reporting. Reported FTE involvement varied widely across hospital sizes and contexts, reflecting heterogeneity in design, role definitions, and reporting practices. Exploratory pooled estimates suggested higher reported ID physicians and ID clinical pharmacists involvement with larger hospitals; however, this pattern was affected by heterogeneity and publication bias and should be interpreted as descriptive, not generalisable. Conclusions: Current evidence does not support definitive staffing benchmarks for antimicrobial stewardship. This review highlights variability in how stewardship functions are organised and resourced. Future research should improve comparability through consistent reporting of stewardship activities, workforce roles, and institutional context.