Antibiotic Stewardship Programs and Antimicrobial Resistance Patterns in Teaching Hospitals

Abstract

Antimicrobial resistance (AMR) is a growing global health threat, undermining the effectiveness of antibiotics and jeopardizing clinical outcomes, particularly in hospital settings. Teaching hospitals serve as critical sites for both high-intensity antibiotic use and training of healthcare professionals, making them vital arenas for implementation of Antibiotic Stewardship Programs (ASPs). ASPs are structured interventions designed to optimize antibiotic usage, reduce inappropriate prescribing, and curb the evolution of resistant pathogens. This study investigates the relationships between the implementation strength of ASPs and antimicrobial resistance patterns observed in teaching hospitals, incorporating mediating effects of prescriber behavior and moderating effects of institutional support.A cross-sectional survey of 650 healthcare professionals and retrospective review of antibiogram data from three urban teaching hospitals were conducted. Five latent constructs were measured: ASP Implementation Strength, Prescriber Behavior, Institutional Support, Antibiotic Utilization Patterns, and AMR Patterns. Structural equation modeling assessed direct, indirect, and interaction effects among constructs to reveal pathways by which stewardship interventions influence resistance outcomes. Results showed that stronger ASP implementation significantly improved prescriber behavior (β = .422, p < .001) and optimized antibiotic utilization (β = .387, p < .001), which in turn were associated with lower prevalence of resistant organisms (β = −.321, p < .001). Institutional support moderated the ASP → Prescriber Behavior link (β = .179, p = .002), indicating that hospitals with greater resources and leadership engagement achieved greater behavior change. Mediation tests confirmed that prescriber behavior and utilization patterns partially mediated the relationship between ASP implementation and observed AMR patterns. These findings highlight the multifactorial impact of stewardship interventions on resistance dynamics in teaching hospitals. They underscore that beyond policy existence, prescriber practices and institutional context critically shape outcomes. Strengthening stewardship frameworks, enhancing education, and securing administrative support are essential for sustainable reductions in AMR. Results inform hospital policy, training curricula, and resource allocation strategies to improve antibiotic use and mitigate resistance trends.