• Anak Agung Istri Agung Sri Stuti Damayanti Master Student of Hospital Administration and Management, Department of Public Health, University of Indonesia
  • Ida Bagus Nyoman Maharjana Master Student of Hospital Administration and Management, Department of Public Health, University of Indonesia
  • Atik Nurwahyuni Researcher, Departement of Public Health, University of Indonesia


Background: Reducing the cost of care and length of stay for patient in hospital are important to monitor the benefits of implementing an antimicrobial management program. An antimicrobial management program is a strategy to decrease Antimicrobial Resistance (AMR) that affect to the treatment of the patient. One of the antimicrobial management programs is Antimicrobial Stewardship Programs (ASP). This study aims to determine the appropriate strategies in the application of Antimicrobial Stewardship Programs (ASP) that can reduce the length of stay and cost of antibiotic consumption for patient in hospital.

Methods: This study was a systematic review that used PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Data obtained from Electronic databases ProQuest and Medline (PubMed) that published five years times span. By using keywords such as antimicrobial stewardship, antimicrobial resistance, length of stay, length of the hospital and patient cost to find the relevant journal. 

Results: The search found 3,541 studies, of which 26 studies were included in the systematic review. After excluded the article review, there were 9 studies that used quasi-experimental, observational cohort studies and Randomized Control Trial (RCT). These studies conducted majority in Europe and USA, only 1 study that conducted in Asia. Analysis of the studies found out that 6 of 9 studies mentioned if ASP can reduce the length of stay of the patient in hospital. Only 3 of 9 studies that examined the effect of ASP in cost of care and these 3 studies mentioned ASP can reduce the cost of care.

Conclusion: This study showed that implementing ASP can reduced the length of stay and antibiotics consumption among patient in hospital by manage the antimicrobial use, conduct audits and feedback in an appropriate step, and intravenous to oral switch program.

Keywords: Antimicrobial stewardship, length of stay, cost of care


WHO, 2015, Antimicrobial Resistance Fact sheet No. 194 WHO homepage

Akalin, E. H. 2002. The Evolution of Guidelines In An Era of Cost Containment. Surgical Prophylaxis.J Hosp infect.

Nathwani, D, et all, 2019, Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review, Antimicrobial Resistance and infection Control.

CDC. Get smart for healthcare. Checklist for Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta: Centers for Disease Control and Prevention; 2013

Bartlett JG, Gilbert DN, Spellberg B. Seven ways to preserve the miracle of antibiotics. Clin Infect Dis. 2013;56(10):1445–1450.

Morrill J. Haley et all, 2016, Impact to Prospective Audit and Feedback Antimicrobial Stewardship Program at a Veterans Affairs Medical Center: A Six-Point Assessment, PLoS ONE (2016); 11(3) 1-15

Campbell, Tonya J, et all, 2016, Every antibiotic, every day: Maximizing the impact of prospective audit and feedback on total antibiotic use (2016), PLoS ONE (2016) 11(3)

Wathne, Jannicke Slettli, Harthug, et al, 2019, The association between adherence to national antibiotic guidelines and mortality, readmission and length of stay in hospital inpatients: results from a Norwegian multicentre, observational cohort study , Antimicrobial Resistance and Infection Control (2019) 8(1) 1-11

Mehta, Jimish M, Haynes, et al, 2014, Comparison of Prior Authorization and Prospective Audit with Feedback for Antimicrobial Stewardship Infection Control & Hospital Epidemiology (2014) 35(9) 1092-1099

Lesprit, Pontfarcy, al, 2015, Postprescription review improves in-hospital antibiotic use- A multicenter randomized controlled trial Clinical Microbiology and Infection (2015): 21 (2) 180.e1 – 180. e7

Rodriguez-Pardo, D.Pigrau, C.2016, Effectiveness of sequential intravenous-to-oral antibiotic switch therapy in hospitalized patients with gram-positive infection: the SEQUENCE cohort study European Journal of Clinical Microbiology and Infectious Diseases (2016): 35 (8), 1269-1276

Rahbarimanesh, Aliakbar, Mojtahedi, 2019, Antimicrobial stewardship program (ASP):an effective implementing technique for the therapy efficiency of meropenem and vancomycin antibiotics inIranian pediatric patients Annals of Clinical Microbiology and Antimicrobials (2019): 18 (1) 1-8

Dona D, Daniele, et al, 2018, Effects of clinical pathway implementation on antibiotic prescriptions for pediatric community-acquired pneumonia, PLoS ONE (2018): 12 (2), 1-16

Murri, R, Taccari F, et al, 2018, A 72-h intervention for improvement of the rate of optimal antibiotic therapy in patients with bloodstream infections, European Journal of Clinical Microbiology and Infectious Diseases, (2018) : 37 (1) 167-173

Daniel Markley, J.Bernard, et al, 2017, De-escalating Antibiotic Use in the Inpatient Setting: Strategies, Controversies, and Challenges, Current Infectious Disease Reports, (2017): 19 (4)

Olsen, Randall J.Musick, William L.Cernoch, et al, 2013, Integrating rapid pathogen identification and antimicrobial stewardship significantly decreases hospital costs, Archives of pathology & laboratory medicine (2013) 137(9) 1247-1254

Laundy. M, Gilchrist Mark, Whitney Laura, Antimicrobial Stewardship, Oxford niversity Press, 2016.



How to Cite

Damayanti, A. A. I. A. S. S., Maharjana, I. B. N., & Nurwahyuni, A. (2019). ANTIMICROBIAL STEWARDSHIP STRATEGY TO REDUCE LENGTH OF STAY AND COST OF ANTIBIOTIC CONSUMPTION: A SYSTEMATIC REVIEW. Proceedings of the International Conference on Applied Science and Health, (4), 352–365. Retrieved from