University of Hertfordshire


  • Monsey McLeod
  • Raheelah Ahmad
  • Nada Shebl
  • Christianne Micallef
  • Fiona Sim
  • Alison Holmes
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Original languageEnglish
Number of pages12
Pages (from-to)1
JournalPLoS Medicine
Journal publication date29 Mar 2019
Publication statusPublished - 29 Mar 2019


Antimicrobial stewardship (AMS) strategies are widely implemented in single healthcare sectors and organisations; however, the extent and impact of integrated AMS initiatives across the whole health economy are unknown.
• Assessing degree of integration of AMS across the whole health economy and its impact is essential if we are to achieve a ‘One Health’ approach to addressing antimicrobial resistance (AMR), and therefore we searched systematically for and analysed published examples of integrated AMS initiatives to address this gap.
• Application of a system-level framework to analyse integration of AMS initiatives across and within healthcare sectors shows that integration is emerging but needs strengthening.
• Findings from a small number of evaluations in high-income countries suggest that antimicrobial prescribing and healthcare-associated infections can be reduced using a multisectoral integrated AMS approach.
• More robust research designs to evaluate and understand the impact of multisectoral integrated AMS are needed, particularly with respect to differing health systems in different countries and local organisational contexts.
• Our analysis highlights a number of challenges and ways forward for enhancing the delivery of AMS through an integrated approach.


© 2019 McLeod et al.

ID: 16553486