Real-world implementation and impact of interventional antimicrobial stewardship programmes in Asian hospital settings: an updated systematic review mapped to IDSA/SHEA recommendations, the WHO Bacterial Priority Pathogens List, and AWaRe antibiotic categories.

Antimicrobial stewardship programmes (ASPs) are central to antimicrobial resistance (AMR) control, but regional evidence from Asian hospitals remains heterogeneous. The aim of this study was to update evidence on inpatient interventional ASP/antimicrobial stewardship programme (AMS) studies in Southeast and East Asia and to map intervention components, antibiotic-use outcomes, and resistance outcomes to Infectious Diseases Society of America/Society for Healthcare Epidemiology of America (IDSA/SHEA) recommendations, World Health Organization Access, Watch, and Reserve (WHO AWaRe) categories, and the WHO Bacterial Priority Pathogens List. MEDLINE via PubMed, Embase, and Scopus was searched for studies published from 20June 2016 to 22March 2026. Eligible studies were adult inpatient interventional ASP/AMS studies reporting antibiotic consumption, AMR incidence, mortality, or costs/expenditures. Two reviewers independently selected studies, extracted data, and assessed quality or risk of bias. Controlled and interrupted time-series designs were assessed using Cochrane Effective Practice and Organisation of Care criteria; non-controlled before-after studies were assessed using Integrated Quality Criteria for Review of Multiple Study Designs--. Synthesis was descriptive because of heterogeneity. Thirty-two studies were included. Most were single-centre (29/32, 90.6%) and conducted in China (22/32, 68.8%) or Singapore (6/32, 18.8%). Preauthorization and/or prospective audit and feedback was the most commonly mapped IDSA/SHEA component (22 studies), followed by education (18 studies), shortest effective duration (13 studies), facility-specific guidelines (9 studies), and computerized clinical decision support (8 studies). Antibiotic-use and cost outcomes were consistently favourable, with AWaRe-classifiable reductions concentrated in Watch- and selected Reserve-category antibiotics. Resistance outcomes were less consistently reported but included reductions in selected WHO critical- and high-priority phenotypes; mortality was generally unchanged. ASPs in Southeast and East Asia are increasingly multi-faceted. This combined implementation and public-health mapping identifies progress and highlights gaps in diagnostic stewardship, special populations, and standardized outcome reporting.