DOI: 10.12688/f1000research.183717.1 ISSN: 2046-1402

Impact of Pharmacist Involvement in Antimicrobial Stewardship Programs on Clinical Outcome and Antibiotic Utilization in Intensive Care Unit: A Systematic Review and Meta-Analysis

Yermia Ademi Dedeo, Andi Desiah Pranada, Luthfiah Pertiwi, Ayunda Nur Hidayatiningsih, Zullies Ikawati
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Abstract* Background Antimicrobial stewardship programs (ASPs) are increasingly implemented in intensive care units (ICUs) to optimize antibiotic therapy, reduce antimicrobial resistance, and improve patient outcomes. Clinical pharmacists contribute to ASP activities through antimicrobial optimization, therapeutic drug monitoring, and de-escalation strategies. However, evidence regarding their impact in ICU settings remains limited. Objective To evaluate the effect of clinical pharmacist involvement in ASPs on mortality, ICU length of stay (LOS), and antibiotic utilization among critically ill patients. Methods This systematic review and meta-analysis followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420261308161) on March 17, 2026. PubMed, Scopus, ScienceDirect, and Cochrane Library were searched for studies published between January 2016 and December 2025. Cohort and quasi-experimental studies assessing pharmacist involvement in ICU-based ASPs were included. Risk of bias was assessed using ROBINS-I, and the certainty of the evidence was evaluated using GRADE. Random-effects meta-analysis was performed using RevMan. Results Fourteen studies from Kuwait, Egypt, Thailand, China, Pakistan, Japan, Korea, Palestine, and the United States were included. Pharmacist involvement in ASPs may reduce mortality among ICU patients (RR = 0.85; 95% CI: 0.73–1.00; I 2  = 34%). Significant mortality reductions were observed in quasi-experimental studies (RR = 0.74; 95% CI: 0.62–0.89) and in pharmacist-led interventions (RR = 0.76; 95% CI: 0.62–0.93). No significant reduction in ICU LOS was observed overall. However, pharmacist-led interventions in cohort studies were associated with shorter ICU stay (MD = −1.43 days; 95% CI: −2.12 to −0.73). Most studies reporting antibiotic utilization demonstrated reductions in therapy duration or DOT after ASP implementation. Evidence certainty was moderate for mortality and very low for ICU LOS. Conclusions Clinical pharmacist involvement in ICU ASPs may reduce mortality and optimize antibiotic use, particularly in pharmacist-led interventions. Further high-quality studies are needed to confirm these findings.

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