AMR Stewardship in Public Hospitals

Antimicrobial resistance represents one of the most critical public health threats facing contemporary healthcare systems, directly elevating inpatient morbidity, prolonged hospital stays, and overall mortality rates [1]. Within public hospital environments, particularly in resource-constrained developing settings, the proliferation of multidrug-resistant pathogens compromises routine clinical procedures and places unsustainable economic pressure on public health infrastructure [3]. The uncoordinated management of antibiotic therapies across inpatient wards exacerbates selective pressure, turning tertiary institutions into epicenters for the transmission of resistant bacterial strains [4]. Systematic antimicrobial stewardship programs have emerged as the primary institutional defense against this crisis, aiming to balance therapeutic efficacy with the containment of resistance drivers [1]. Despite established international recommendations and national policy guidelines, significant implementation deficits persist within public tertiary healthcare facilities [5]. Routine clinical practice frequently relies on broad-spectrum empirical regimens rather than microbiological laboratory diagnostics, leading to extensive deviations from standard therapeutic guidelines and disproportionate utilization of restricted antibiotic classes [3, 6]. Concurrently, structural challenges including inadequate diagnostic infrastructure, unregulated medicine distribution, and acute gaps in continuous medical education impede the operationalization of institutional stewardship committees [5]. Furthermore, heightened pressure on public hospital wards during epidemic surges fosters defensive prescribing practices that compound systemic vulnerability [2]. The primary aim of this work is to evaluate the institutional, clinical, and microbiological dimensions of antimicrobial stewardship across public hospital facilities and formulate systematic strategies for rational utilization. By synthesising evidence from published point-prevalence studies, multi-centre surveillance registries, and healthcare provider prescribing evaluations, the investigation delineates key operational barriers to effective governance. The resulting findings provide practical models for clinical decision support, institutional audit-and-feedback loops, and policy-aligned formulary controls designed specifically for tertiary public health systems.