Antimicrobial Stewardship Programs and Antibiotic Resistance Control: The Mediating Role of Clinical Compliance and Institutional Policy

Abstract

Antimicrobial resistance (AMR) has emerged as a major global health threat, resulting in increased morbidity, mortality, and healthcare costs. Inappropriate and excessive use of antibiotics in healthcare settings is a key driver of antibiotic resistance, highlighting the urgent need for effective control strategies. Antimicrobial stewardship programs (ASPs) are evidence-based interventions designed to optimize the use of antimicrobials, improve patient outcomes, and reduce the development of antibiotic resistance. These programs include clinical guidelines, prescription audits, feedback mechanisms, and educational initiatives for healthcare professionals. Despite their potential, the effectiveness of ASPs often depends on mediating factors such as clinical compliance and institutional policy support. Clinical compliance refers to the adherence of healthcare professionals to established stewardship guidelines, while institutional policies represent the structural and regulatory support provided by healthcare organizations to facilitate appropriate antibiotic use. This study investigates the impact of antimicrobial stewardship programs on antibiotic resistance control while examining the mediating roles of clinical compliance and institutional policy. A quantitative research design was adopted, with data collected through structured questionnaires administered to healthcare professionals, including physicians, pharmacists, and infection control staff in hospitals. Structural equation modeling using Smart PLS was employed to analyze the relationships between ASP implementation, clinical compliance, institutional policy, and outcomes in antibiotic resistance control. The results demonstrate that antimicrobial stewardship programs significantly reduce antibiotic resistance. Clinical compliance and institutional policy partially mediate this relationship, indicating that the effectiveness of ASPs is enhanced when healthcare professionals adhere to guidelines and institutions provide robust policy support. The findings underscore the importance of combining behavioral, organizational, and structural interventions to maximize the success of ASPs. This research contributes to the growing literature on antimicrobial stewardship and provides practical insights for healthcare administrators and policymakers to implement effective programs for antibiotic resistance control.