Hospital-Driven Antimicrobial Resistance: A Comprehensive Evidence-Based Synthesis Of Drivers, Transmission, And Control Strategies
DOI:
https://doi.org/10.53555/jaz.v46i2.5333Keywords:
Antimicrobial resistance; Drug-resistant infections; Hospital-acquired infections; Antimicrobial stewardship; Infection prevention and control; Healthcare-associated transmission; Surveillance; Public healthAbstract
Antimicrobial resistance (AMR) is one of the most important global public health concerns of the twenty-first century, and hospital settings play a critical role in the emergence, amplification, and dissemination of drug-resistant illnesses. Healthcare facilities offer the ideal conditions for the selection and spread of resistance due to the concentration of vulnerable patient groups, widespread use of antibiotics, invasive procedures, and complex care pathways. This study evaluates the effectiveness of hospital-based management strategies and offers a comprehensive, evidence-based summary of the ways in which hospitals fuel antibiotic resistance. A PRISMA-informed evidence synthesis assisted by Litmaps citation-network analysis was used to locate and examine recent and significant literature from Scopus, Web of Science, PubMed, and Crossref-indexed sources. Twenty-five papers that met the inclusion criteria were subjected to a qualitative synthesis. The primary hospital-specific drivers of resistance found in the analysis include inappropriate antimicrobial prescribing, selective pressure from broad-spectrum agents, inadequate infection prevention and control (IPC) practices, environmental contamination, and healthcare-associated transmission through patients, healthcare personnel, and shared equipment. High-priority pathogens like methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, multidrug-resistant Gram-negative bacteria, and Clostridium difficile are highlighted because of their disproportionate role in healthcare-associated infections, prolonged hospital stays, increased healthcare costs, and mortality. Numerous studies show that antimicrobial stewardship programs are the most effective hospital-based approach for reducing antibiotic use and resistance rates. Although IPC bundles, surveillance systems, rapid diagnosis, and environmental cleaning all cooperate to limit transmission pathways, their results vary based on the resources, infrastructure, and adherence of each location. Underappreciated elements that contribute to the persistence of resistance include environmental reservoirs and intra-hospital transmission networks. This synthesis emphasizes that hospital-driven AMR is a systemic problem that cannot be solved by isolated initiatives. Coordinated, context-specific actions combining antimicrobial stewardship, robust IPC, environmental control, and surveillance are essential to reducing the incidence of drug-resistant diseases and preserving the effectiveness of currently available antimicrobials.
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