BEHAVIORAL STEWARDSHIP TO OPTIMIZE ICU ANTIBIOTIC USE IN RESOURCE-LIMITED SETTINGS
Author(s)
Arslan Khan, MSc, PharmD1, Saima Mushtaq, PhD2, Amjad Khan, MPhil, RPh, PharmD, PhD3, Jie Chang, PharmD, MSc, PhD4, Yu Fang, PharmD, MSc, PhD5.
1Chapter President | Postgraduate Researcher @ CDSP, XJTU, Xi'an JiaoTong University, Bannu, Pakistan, 2School of Pharmacy, Xi'an Jiaotong University, Xi'an China, Xi’an, China, 3Quaid-i-Azam University, Islamabad, Pakistan, 4School of Pharmacy, Xi'an Jiaotong University, Xi’an, China, 5Xi'an Jiaotong University, Xi'an, China.
1Chapter President | Postgraduate Researcher @ CDSP, XJTU, Xi'an JiaoTong University, Bannu, Pakistan, 2School of Pharmacy, Xi'an Jiaotong University, Xi'an China, Xi’an, China, 3Quaid-i-Azam University, Islamabad, Pakistan, 4School of Pharmacy, Xi'an Jiaotong University, Xi’an, China, 5Xi'an Jiaotong University, Xi'an, China.
OBJECTIVES: Antimicrobial resistance (AMR) imposes avoidable clinical and economic burden on health systems, with intensive care units (ICUs) representing high-risk sites for broad-spectrum antibiotic use. This study proposes a health-system value model that integrates antibiotic utilization surveillance, behavioral science, and pragmatic trial evaluation to reduce inappropriate ICU antibiotic prescribing in a resource-limited setting.
METHODS: A sequential mixed-methods design with an embedded cluster randomized controlled trial will be implemented over 18 months. Phase 1 will establish baseline systemic antibiotic use through retrospective chart review of adult ICU patients, using WHO AWaRe classification and appropriateness assessment. Phase 2 will assess prescribing determinants among ICU physicians using a 42-item COM-B questionnaire and semi-structured interviews with 20 physicians. Phase 3 will randomize 10 ICU clusters 1:1 to a COM-B-tailored stewardship intervention or usual care. Intervention components include accountable justification prompts, real-time alternative suggestions, and monthly peer-comparison feedback. Primary outcome is the proportion of inappropriate antibiotic prescriptions; secondary outcomes include antibiotic consumption, local resistance patterns, ICU length of stay, mortality, and COM-B domain changes.
RESULTS: The proposed framework is designed to move antimicrobial stewardship from passive audit to behaviorally targeted implementation. It will generate three decision-relevant outputs: standardized baseline antibiotic-use evidence, a mapped behavioral diagnosis of prescribing drivers, and cluster-randomized estimates of intervention impact. The model targets at least a 20% reduction in inappropriate antibiotic use and will produce data relevant to resource use, quality of care, and AMR policy translation.
CONCLUSIONS: This protocol offers a scalable HEOR-oriented framework for linking real-world antibiotic utilization, implementation science, and health-system value. If effective, it can support evidence-based investment in ICU antimicrobial stewardship across similar resource-constrained settings.
METHODS: A sequential mixed-methods design with an embedded cluster randomized controlled trial will be implemented over 18 months. Phase 1 will establish baseline systemic antibiotic use through retrospective chart review of adult ICU patients, using WHO AWaRe classification and appropriateness assessment. Phase 2 will assess prescribing determinants among ICU physicians using a 42-item COM-B questionnaire and semi-structured interviews with 20 physicians. Phase 3 will randomize 10 ICU clusters 1:1 to a COM-B-tailored stewardship intervention or usual care. Intervention components include accountable justification prompts, real-time alternative suggestions, and monthly peer-comparison feedback. Primary outcome is the proportion of inappropriate antibiotic prescriptions; secondary outcomes include antibiotic consumption, local resistance patterns, ICU length of stay, mortality, and COM-B domain changes.
RESULTS: The proposed framework is designed to move antimicrobial stewardship from passive audit to behaviorally targeted implementation. It will generate three decision-relevant outputs: standardized baseline antibiotic-use evidence, a mapped behavioral diagnosis of prescribing drivers, and cluster-randomized estimates of intervention impact. The model targets at least a 20% reduction in inappropriate antibiotic use and will produce data relevant to resource use, quality of care, and AMR policy translation.
CONCLUSIONS: This protocol offers a scalable HEOR-oriented framework for linking real-world antibiotic utilization, implementation science, and health-system value. If effective, it can support evidence-based investment in ICU antimicrobial stewardship across similar resource-constrained settings.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD33
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Study Approaches
Disease
Infectious Disease (non-vaccine), No Additional Disease & Conditions/Specialized Treatment Areas, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)