Combating Antimicrobial Resistance: Insights from Antimicrobial Stewardship Research

An Insight into the Evaluation of Antimicrobial Stewardship Prior to and During the COVID-19 Pandemic, and its Role in Combating Antimicrobial Resistance under the United Nations Sustainable Development Goals Framework 'SDG 3 and Me'
Published in Sustainability
Combating Antimicrobial Resistance: Insights from Antimicrobial Stewardship Research
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BioMed Central
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Antimicrobial stewardship implementation before and during the COVID-19 pandemic in the acute care settings: a systematic review - BMC Public Health

Introduction Antibiotics are widely administered for various indications, leading to increased antimicrobial resistance (AMR) in acute care hospitals. Since the onset of the COVID-19 pandemic, Antimicrobial Stewardship (AMS) effective strategies should be used to maintain the rational use of antibiotics and decrease the threat of Antimicrobial Resistance (AMR). Aim This systematic literature review aims to investigate the AMS intervention Before-the-pandemic (BP) and During-the-pandemic (DP) from the literature. Design and setting Systematic literature review of primary studies on AMS implementation in acute care settings. Methods Relevant studies published between 2000 and March 2021 were obtained from Medline (via PubMed), OVID, CINAHL, International Pharmaceutical Abstracts, Psych Info, Scopus, Web of Science, Cochrane Library, OpenGrey, and Google Scholar, using a comprehensive list of search terms. Public Health England (PHE) toolkit was agreed upon as a gold standard for the AMS implementation. Results There were 8763 articles retrieved from the databases. Out of these, 13 full-text articles met the inclusion criteria for the review. The AMS implementation was identified in the included studies into AMS strategies (Core strategies & Supplemental strategies), and AMS measures BP and DP. Conclusion This Systematic literature review summarises AMS implementation strategies and measures all over the previous 20 years of research. There are many lessons learnt from COVID-19 pandemic. The proper selection of the AMS implementation strategies and measures appeared to be effective in maintaining the appropriate use of antibiotics and decreasing the AMR threat, especially during the COVID-19 pandemic. Further studies are required to provide empirical data to evaluate the AMS implementation and identify which of these strategies and measures were effective BP and DP. In order to be prepared for any emergency/crisis or future pandemics.


I am Rasha Abdelsalam Elshenawy, I am a Clinical Pharmacist by background doing my PhD at the University of Hertfordshire in the UK. I am an Antimicrobial Stewardship Global Lead. I have an American Board of Pharmacy with 20 years of experience, and I am certified in Antimicrobial Stewardship. I have special interests in antimicrobial resistance (AMR) and antimicrobial stewardship (AMS). I led AMS and put measures against antibiotic-resistant bacteria and Five-years AMS strategic plan.



I am a director of FADIC Antimicrobial Stewardship School, which was shortlisted for the Antibiotic Guardian award (2020). This school was shared in the Centre for Disease Control and Prevention (CDC) AMR challenge in 2018. Realising the global burden of AMR has fulfilled my passion for finding possible solutions to AMR through effective implementation of AMS and improving antibiotic prescribing and education





  • The World Antibiotic Awareness Week (WAAW) highlights the importance of responsible antibiotic use and education on antimicrobial resistance and antimicrobial stewardship.
  • The urgency to combat an AMR has never been greater. With projections of 10 million deaths annually by 2050 due to AMR, the importance of antibiotic awareness is paramount.
  • My experience conducting AMR research at Bedfordshire Hospitals NHS Foundation Trust has been pivotal in understanding this crisis.
  • I extend heartfelt thanks to the antimicrobial stewardship pharmacists at the Trust. Their collaboration in promoting AMR research has been invaluable. Likewise, the Research and Development (R&D) department within the Trust deserves recognition for their support in my PhD research project, which investigated antimicrobial stewardship before and during the COVID-19 pandemic.
  • The invaluable contributions at Bedfordshire Hospitals NHS Foundation Trust have been made by a team of dedicated professionals, including AMS pharmacists (Faisal Khan, Abdul Mohamed, and Suraiya Chandratillake), Chief Pharmacist  (Pritesh Bodalia), Head of Pharmacy at Luton & Dunstable University Hospital (Ravi Sharma), Head of Pharmacy at Bedford Hospital (Gemma McGuigan), AMS Lead, and Microbiology Consultant (Dr Mulla Rohinton).
  • The Research & Development (R&D) department, with Assistant Director of R&D (Dr. Mohammad Wasil), and Manager of Research and Development (Margaret Louise Tate), have also played a crucial role.
  • Acknowledgements extend to the former lead specialist pharmacist in training and development (Patricia Edwards), as well as the Trust's communication team.
  • Their support and assistance have been pivotal in maintaining the success of our research. From reviewing retrospective medical records to conducting prospective surveys among healthcare professionals, their contributions have significantly shaped the comprehensive outcomes of our research. This collaboration promotes an integerated antibiotic prescribing and antimicrobial stewardship investigation, thereby fostering antimicrobial stewardship and combating antimicrobial resistance (AMR).
  • I am also grateful to the University of Hertfordshire, School of Life and Medical Sciences, for sponsoring this research. The support from university supervisors (Prof Zoe Aslanpour and Dr Nkiruka Umaru) and the statistical support department has maintained the quality and excellence of the research. 



Key takeaways from this sustainable research project include:

  1. A multidisciplinary team is essential for a consistent, integrated research project.
  2. Collaboration between academia and NHS trusts is crucial for evidence-based research to address AMR.
  3. Future AMR research is vital for developing integrated tools and understanding the necessary elements for effective AMS implementation.
  4. Healthcare professionals are committed to proper antibiotic use, but clinical judgment and practice situations can be challenging.
  5. Antimicrobial stewardship is more than judicious antibiotic use; it's a lifestyle in clinical practice.
  6. The output of this research is a comprehensive roadmap for AMS implementation, including dynamic dashboards and educational programs.
  7. The COVID-19 pandemic has highlighted the impact of AMR on mortality.
  8. The loss due to antibiotic misuse highlights the urgent need for rational antibiotic use.



In conclusion, my gratitude goes to the AMS team at Bedfordshire Hospitals NHS Foundation Trust for their support throughout my academic journey and the University of Hertfordshire. Their dedication has not only aided my research but also contributes significantly to the global fight against AMR.



Dissemination of this Research Project



To read the Final Report of the 'COVID-19 Impact on Antimicrobial Stewardship', contact the Principal Investigator, Rasha Abdelsalam Elshenawy.

Email: r.a.elshenawy@herts.ac.uk

Publication Date: 23 November 2023.

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