The role of digital tools and artificial intelligence in supporting antimicrobial stewardship: Study protocol for a systematic review

Abstract

INTRODUCTION: Since the post-antibiotic era, there has been significant difficulty in treating infectious diseases due to the increase in antimicrobial resistance, the scarcity of new antimicrobials, and the complexity of the healthcare system. The World Health Organization (WHO) recognized it as one of the main public health problems. To mitigate this issue, Antimicrobial Stewardship Programs (ASPs) have been established in hospital settings and in primary care, through multidisciplinary teams with specific objectives and measurable results. However, their implementation faces multiple challenges. Digital tools and artificial intelligence (AI) can enhance these ASPs, contributing to the discovery of new molecules, the identification of resistance patterns, and improvements in infection control and prevention. OBJECTIVE: To analyze the role of digital tools and AI in the interventions carried out by hospital-based ASP teams to improve established outcomes. MATERIAL AND METHODS: This protocol follows the PRISMA-P methodology and has been registered in PROSPERO (ID: CRD42024601221). A literature search will be conducted in PubMed, Scopus, and the Cochrane Library (2014-2024); gray literature will subsequently be reviewed in Google Scholar. Articles (clinical trials, interventional and observational) involving hospitalized adult patients requiring antimicrobial treatment will be included. The risk of bias will be assessed according to the study type, and methodological quality will be evaluated using the GRADE scale. Two independent researchers will perform study selection, quality assessment, and data extraction. Discrepancies will be resolved by consensus or through the intervention of a third researcher. DISCUSSION: Previous studies highlight the role of ASPs and digital tools in antimicrobial optimization. However, the difficulty and difference in the degree of implementation have also become apparent. The heterogeneity of interventions and indicators could be a limiting factor for conducting a meta-analysis. Despite these limitations, this systematic review will provide a better understanding of the potential use of digital tools and AI in hospital-based ASPs. PROTOCOL REGISTRATION: This protocol has been registered in PROSPERO with the ID: CRD42024601221.

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