Antimicrobial Stewardship in Ireland (2010-2021): a scoping review protocol

Fiona Barry; Maura P Smiddy; Anthony P Fitzgerald; Eilis J. O’Reilly; Olive Murphy

doi:10.12688/hrbopenres.13917.1

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Study Protocol

Antimicrobial Stewardship in Ireland (2010-2021): a scoping review protocol

[version 1; peer review: 2 approved with reservations]

Fiona Barry ¹, Maura P Smiddy¹, Anthony P Fitzgerald², Eilis J. O’Reilly¹, Olive Murphy³

Fiona Barry ¹, Maura P Smiddy¹, [...] Anthony P Fitzgerald², Eilis J. O’Reilly¹, Olive Murphy³

PUBLISHED 31 Jul 2024

Author details Author details

¹ School of Public Health, University College Cork, Cork, Cork, T12XF62, Ireland
² School of Mathematical Sciences and School of Public Health, University College Cork, Cork City, Cork, Cork, T12XF62, Ireland
³ Bons Secours Health System, College Road, Cork, Cork, T12 DV56, Ireland

Fiona Barry
Roles: Conceptualization, Investigation, Methodology, Project Administration, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Maura P Smiddy
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

Anthony P Fitzgerald
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

Eilis J. O’Reilly
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

Olive Murphy
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Antimicrobial stewardship programmes (ASP) are essential in promoting responsible antimicrobial use, reducing antimicrobial resistance (AMR) and health care-associated infections. In 2009 the Strategy for the Control of Antimicrobial Resistance in Ireland (SARI), Hospital Antimicrobial Stewardship Working Group published guidance on antimicrobial stewardship (AMS) in hospitals. This paper presents a protocol for a scoping review which aims to examine the current literature to evaluate progress related to the implementation of the SARI (2009) guidance on antimicrobial stewardship in hospitals in Ireland.

Methods

This scoping review will be conducted in line with the five-stage methodological framework by Arksey & O’Mally 2005. We will search the following databases (PubMed, CINAHL, Embase, Web of Science) and targeted websites for articles and reports for possible inclusion in our review. Studies pertaining to AMS undertaken or related to the Republic of Ireland from January 2010 until December 2021 will be included. We will include all study designs. We will map all selected publications to the recommendations of the SARI (2009) guidance document. The protocol follows the guidance of Peters et al., 2022. Two reviewers will independently screen studies and reports to assess eligibility with any discrepancies resolved by consensus discussion with a third reviewer.

Results

These will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR)and this checklist will be included when the scoping review is published.

Conclusion

This scoping review will map studies and reports to evaluate AMS in relation to national guidelines without restriction on study design or outcomes in the Republic of Ireland. This information has the potential to provide a valuable resource for the implementation of future AMS research and interventions.

Keywords

antimicrobial stewardship, Ireland, scoping review

Corresponding author: Fiona Barry

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Barry F et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Barry F, Smiddy MP, Fitzgerald AP et al. Antimicrobial Stewardship in Ireland (2010-2021): a scoping review protocol [version 1; peer review: 2 approved with reservations]. HRB Open Res 2024, 7:52 (https://doi.org/10.12688/hrbopenres.13917.1) First published: 31 Jul 2024, 7:52 (https://doi.org/10.12688/hrbopenres.13917.1) Latest published: 24 Jan 2025, 7:52 (https://doi.org/10.12688/hrbopenres.13917.2)

Introduction

The escalating threat posed to human life by antimicrobial resistance (AMR) has intensified over the last 20 years primarily due to the use, abuse, and excessive consumption of antimicrobials agents- antifungals, antiparasitic, antivirals and antibiotics^1–2. These drugs prevent and treat infections, however the global emergence of resistance has compromised their efficacy³.

Antimicrobial stewardship (AMS) is a methodical approach targeted at ensuring the appropriate use of antimicrobials thereby mitigating the emergence of resistance⁴.

Antimicrobial Stewardship Programmes (ASP) have been shown to be crucial component of this effort⁵.

Ireland’s first national document on AMR was published in 2001⁶. Specific guidelines on AMS in hospitals were most recently published in 2009⁷ by the Strategy for the Control of Antmicobial Resistance (SARI) Committee, reporting to the Health Service Executive and comprised a multidisciplinary team of clinical and academic experts. The guidelines⁷ summarised recommendations across four key categories: Structure and Organisation, Role of Prescribers, AMS Interventions, and Non acute Residential Healthcare Institutions⁷.

The aim of this review is to document the progress in AMS implementation in Ireland, mapping the findings to the SARI 2009⁷ recomendations.

Study rationale

To date, the implementation of AMS has not been evaluated in the Irish healthcare setting.

Dissemination

The results will be shared with AMS teams, presented at conferences, and published as a scoping review.

Methods

Scoping reviews are conducted when there is extensive evidence on a topic involving academic publications, grey literature, and includes other sources⁸. This protocol is reported in accordance with JBI Best practice guidelines and reporting items for the mdevelopment of scoping reviews protocols⁹.

The review process will involve five steps: “(1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; (5) collating, summarising and reporting the results”^{10 (p1)}

Stage 1: Identifying the research question

The research question was identified by asking what progress has been made in relation to the implementation of AMS interventions in healthcare settings in Ireland since the publication of the SARI report in 2009.

The research objectives

1. To present evidence of the progress of AMS implementation since the publication of the guidelines⁷.

2. To identify systems that facilitate or hinder the successful implementation of AMS guidelines from publication in 2009 to 2021.

Stage 2: Identifying the relevant studies

Based on our research question, we will explore academic databases and grey literature targeting organisations’ websites. Following discussions among all reviewers and a research librarian, we have identified four academic databases: Embase (Elsevier), PubMed, CINHAL, and Web of Science (Clarivate) to search.

Initially, one reviewer performed a preliminary search to identify common terms and headings, which were then refined according to the focus of this review. We will employ Boolean operators to combine keywords for a more targeted search and examine the reference lists of our chosen studies for potential inclusion. Authors will be contacted if further information about their studies is required.

Inclusion Criteria: studies on antimicrobial stewardship focussing on antibiotics; studies originating or relevant to Ireland; literature published in the English language; publications from 01 January 2010 to 31 December 2021. There are no limitations on study designs.

Exclusion Criteria: studies on antimicrobial stewardship focussing on other antimicrobials; studies outside Ireland; conference abstracts, editorials theses, reviews, and opinion pieces.

Grey literature search

Based on our research question asked and keywords previously identified we will search the following targeted websites for publications from January 2010–December 2021.

The Health Information and Quality Authority (HIQA),
The Health Service Executive (HSE)
The Health Protection Surveillance Centre (HPSC)
The European Centre for Disease Prevention and Control (ECDC)
The World Health Organization (WHO) publications related to AMS

Once our search is complete all selected studies and reports that meet our inclusion criteria will be downloaded to Mendeley¹¹ and duplicates removed.

Stage 3: Study selection

The selected title and abstracts will be uploaded to the online tool Covidence¹² for screening and retrieve full texts of publications. The reasons for exclusion based on our criteria will be documented in our review. Two reviewers (FB and EOR) will independently undertake screening and any queries that arise will be facilitated by further discussions involving an additional reviewer (OM). Full texts of remaining publications will then be screened for inclusion.

Stage 4: Charting the data

The following information will be extracted and entered into an MS Excel database¹³: authors, study details year, objectives, research methods, study populations and findings that are aligned to the SARI 2009 recommendations. Any deviations to the original proposal will be documented in the methods section of the review.

Stage 5: Collating, summarising, reporting the results

The selected studies will be mapped to the 2009 SARI recommendations⁷ and the PRISMA-ScR guidelines will be used to report the findings¹⁴. The screening process will be presented in a PRISMA flow chart. Due to the broad nature of the research question, a quality appraisal is not essential for this scoping review⁹.

Discussion

To our knowledge, this is the first study to map peer reviewed studies and reports to the four recommendations of the first national AMS strategy in order to document progress.

Ethics and consent

Ethical approval and consent were not required

Data availability

No data are associated with this article

Acknowledgements

The authors acknowledge Ms. Virginia Conrick, Academic Success Librarian, University College Cork.

Faculty Opinions recommended

References

1. World Health Organization: Antimicrobial Resistance. Geneva: Key Facts. 2018; (accessed June 06, 2024). Reference Source
2. European Centre for Disease Prevention and Control (ECDC): European Antimicrobial Resistance Surveillance Network (EARS-Net). Reference Source
3. Darby EM, Trampari E, Siasat P, et al.: Molecular mechanisms of antibiotic resistance revisited. Nat Rev Microbiol. 2023; 21(5): 280–95. PubMed Abstract | Publisher Full Text
4. Aryee A, Price N: Antimicrobial Stewardship - can we afford to do without it? Br J Clin Pharmacol. 2015; 79(2): 173–81. PubMed Abstract | Publisher Full Text | Free Full Text
5. Ohl CA, Luther VP: Antimicrobial Stewardship for inpatient facilities. J Hosp Med. 2011; 6(S1): S4–15. PubMed Abstract | Publisher Full Text
6. National Disease Surveillance Centre: SARI. A strategy for the control of Antimicrobial Resistance in Ireland. Report of the subgroup of the scientific advisory committee of the National Disease Surveillance Centre. NDSC, 2001. Reference Source
7. Health Protection Surveillance Centre: SARI Hospital Antimicrobial Stewardship Working Group: Guidelines for Antimicrobial Stewardship in hospitals in Ireland. Dublin: Health Protection Surveillance Centre, 2009. Reference Source
8. Peters MDJ, Marnie C, Tricco AC, et al.: Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020; 18(10): 2119–2126. PubMed Abstract | Publisher Full Text
9. Peters MDJ, Godfrey C, McInerney P, et al.: Best practice guidance and reporting items for the development of scoping review protocols. JBI Evid Synth. 2022; 20(4): 953–968. PubMed Abstract | Publisher Full Text
10. Levac D, Colquhoun H, O'Brien KK: Scoping studies: advancing the methodology. Implement Sci. 2010; 5: 69. PubMed Abstract | Publisher Full Text | Free Full Text
11. Mendeley—reference management software & researcher network. [cited 2024 June 06]. Reference Source
12. Covidence systematic review software. Veritas Health Innovation, Melbourne, Australia.
13. Microsoft Corporation: Microsoft excel. 2018. Reference Source
14. Tricco AC, Lillie E, Zarin W, et al.: PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169(7): 467–73. PubMed Abstract | Publisher Full Text

Comments on this article Comments (0)

Version 2

VERSION 2 PUBLISHED 31 Jul 2024

Author details Author details

Fiona Barry
Roles: Conceptualization, Investigation, Methodology, Project Administration, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Maura P Smiddy
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

Anthony P Fitzgerald
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

Eilis J. O’Reilly
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

Olive Murphy
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

version 2

Revised

Published: 24 Jan 2025, 7:52

https://doi.org/10.12688/hrbopenres.13917.2

version 1

Published: 31 Jul 2024, 7:52

https://doi.org/10.12688/hrbopenres.13917.1

© 2024 Barry F et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Barry F, Smiddy MP, Fitzgerald AP et al. Antimicrobial Stewardship in Ireland (2010-2021): a scoping review protocol [version 1; peer review: 2 approved with reservations]. HRB Open Res 2024, 7:52 (https://doi.org/10.12688/hrbopenres.13917.1)

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PUBLISHED 31 Jul 2024

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Reviewer Report 28 Sep 2024

Direk Limmathurotsakul, Microbiology, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok / กรุงเทพมหานคร, Thailand

Approved with Reservations

https://doi.org/10.21956/hrbopenres.15266.r42350

The article by Barry et al is a scoping review protocol evaluating AMS implementation in Ireland. The review will focus on studies relevant to Ireland. The availability of the datasets is not appliable as this is a study protocol. The article and protocol are well-written.

I have few minor comments for consideration.
1) The primary objective of the scoping review is to evaluate evidence of the 'progress' of AMS implementation. It would be clearer if the authors described potential indicators or outcomes, models or theories they will use to monitor the 'progress'. For example, will authors primarily use a set of structural indicators, process indicators and outcome indicators for AMS? or will they include other indicators to monitor the progress? Although the study aims to be broad due to the nature of the research question, providing a list of potential methods to be used could make the methods clearer and allow for replication by others.

2) The second objective of the scoping review is to identify ‘systems’ that facilitate or hinder the successful implementation of AMS guidelines. It would be clearer if the authors stated which models or theories the review will use to identify and categorize barriers and enablers to implementation. The authors use the word ‘systems’, but it is unclear whether they will include all domains of potential barriers and facilitators to AMS implementation or focus on only a few domains (e.g., focusing only on environmental context and resources, and behavioral regulation, but not collecting data on studies evaluating social influence on AMS).

3) In ‘Stage 5’, the authors state that they aim not to use a quality appraisal due to the broad nature of the research question. While this approach may be acceptable, it would still be beneficial to conduct a quality appraisal for any studies/literature that are possible and provide that information to the readers. For studies that cannot be appraised, they can be noted as ‘not applicable’ and provide reasons why it is not possible. This approach would allow readers to understand the quality of the studies included in the review. If none of the studies/literature being reviewed can be appraised for quality, it would still be helpful to provide individual reasons for each study/literature to the readers.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Infectious Diseases, Tropical Infectious Diseases, Antimicrobial resistance

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 18 Dec 2024

Fiona Barry, School of Public Health, University College Cork, Cork, T12XF62, Ireland

18 Dec 2024

Author Response

Thank you for reviewing this protocol. Please see the responses to your comments below:

The primary objective of the scoping review is to evaluate evidence of the 'progress' of ... Continue reading Thank you for reviewing this protocol. Please see the responses to your comments below:

The primary objective of the scoping review is to evaluate evidence of the 'progress' of AMS implementation. It would be clearer if the authors described potential indicators or outcomes, models or theories they will use to monitor the 'progress'. For example, will authors primarily use a set of structural indicators, process indicators and outcome indicators for AMS? or will they include other indicators to monitor the progress? Although the study aims to be broad due to the nature of the research question, providing a list of potential methods to be used could make the methods clearer and allow for replication by others.

Response: Thank you. To clarify how progress will be ascertained, we will add the following text:
This paper presents a protocol for a scoping review which describes the progress of the implementation of the recommendations of the 2009 National Strategy for Antimicrobial Resistance in Ireland report. Papers or reports on AMS in Ireland will be mapped to the list of recommendations. These recommendations are detailed in the introduction.

The second objective of the scoping review is to identify ‘systems’ that facilitate or hinder the successful implementation of AMS guidelines. It would be clearer if the authors stated which models or theories the review will use to identify and categorize barriers and enablers to implementation. The authors use the word ‘systems’, but it is unclear whether they will include all domains of potential barriers and facilitators to AMS implementation or focus on only a few domains (e.g., focusing only on environmental context and resources, and behavioural regulation, but not collecting data on studies evaluating social influence on AMS).

Response: Thank you. Objective 2: We have reworded objective 2 to reflect that we are not engaging in a full review to find the barriers and facilitators of implementation. The new wording is as follows “To explore factors in the included studies that may have supported or hindered progress.”
The overall evidence will be mapped to four recommendation categories in the 2009 National Strategy for Antimicrobial Resistance in Ireland with a targeted summary of achievements and challenges per category.

In ‘Stage 5’, the authors state that they aim not to use a quality appraisal due to the broad nature of the research question. While this approach may be acceptable, it would still be beneficial to conduct a quality appraisal for any studies/literature that are possible and provide that information to the readers. For studies that cannot be appraised, they can be noted as ‘not applicable’ and provide reasons why it is not possible. This approach would allow readers to understand the quality of the studies included in the review. If none of the studies/literature being reviewed can be appraised for quality, it would still be helpful to provide individual reasons for each study/literature to the readers.

Response: Thank you.
While we agree, this is a scoping review and acceptable not to undertake a quality appraisal. However, we anticipate many of our sources will be from the grey literature and therefore not suitable for appraisal.
Thank you for reviewing this protocol. Please see the responses to your comments below:

The primary objective of the scoping review is to evaluate evidence of the 'progress' of AMS implementation. It would be clearer if the authors described potential indicators or outcomes, models or theories they will use to monitor the 'progress'. For example, will authors primarily use a set of structural indicators, process indicators and outcome indicators for AMS? or will they include other indicators to monitor the progress? Although the study aims to be broad due to the nature of the research question, providing a list of potential methods to be used could make the methods clearer and allow for replication by others.

Response: Thank you. To clarify how progress will be ascertained, we will add the following text:
This paper presents a protocol for a scoping review which describes the progress of the implementation of the recommendations of the 2009 National Strategy for Antimicrobial Resistance in Ireland report. Papers or reports on AMS in Ireland will be mapped to the list of recommendations. These recommendations are detailed in the introduction.

The second objective of the scoping review is to identify ‘systems’ that facilitate or hinder the successful implementation of AMS guidelines. It would be clearer if the authors stated which models or theories the review will use to identify and categorize barriers and enablers to implementation. The authors use the word ‘systems’, but it is unclear whether they will include all domains of potential barriers and facilitators to AMS implementation or focus on only a few domains (e.g., focusing only on environmental context and resources, and behavioural regulation, but not collecting data on studies evaluating social influence on AMS).

Response: Thank you. Objective 2: We have reworded objective 2 to reflect that we are not engaging in a full review to find the barriers and facilitators of implementation. The new wording is as follows “To explore factors in the included studies that may have supported or hindered progress.”
The overall evidence will be mapped to four recommendation categories in the 2009 National Strategy for Antimicrobial Resistance in Ireland with a targeted summary of achievements and challenges per category.

In ‘Stage 5’, the authors state that they aim not to use a quality appraisal due to the broad nature of the research question. While this approach may be acceptable, it would still be beneficial to conduct a quality appraisal for any studies/literature that are possible and provide that information to the readers. For studies that cannot be appraised, they can be noted as ‘not applicable’ and provide reasons why it is not possible. This approach would allow readers to understand the quality of the studies included in the review. If none of the studies/literature being reviewed can be appraised for quality, it would still be helpful to provide individual reasons for each study/literature to the readers.

Response: Thank you.
While we agree, this is a scoping review and acceptable not to undertake a quality appraisal. However, we anticipate many of our sources will be from the grey literature and therefore not suitable for appraisal.
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 18 Dec 2024

Fiona Barry, School of Public Health, University College Cork, Cork, T12XF62, Ireland

18 Dec 2024

Author Response

Thank you for reviewing this protocol. Please see the responses to your comments below:

The primary objective of the scoping review is to evaluate evidence of the 'progress' of ... Continue reading Thank you for reviewing this protocol. Please see the responses to your comments below:

The primary objective of the scoping review is to evaluate evidence of the 'progress' of AMS implementation. It would be clearer if the authors described potential indicators or outcomes, models or theories they will use to monitor the 'progress'. For example, will authors primarily use a set of structural indicators, process indicators and outcome indicators for AMS? or will they include other indicators to monitor the progress? Although the study aims to be broad due to the nature of the research question, providing a list of potential methods to be used could make the methods clearer and allow for replication by others.

Response: Thank you. To clarify how progress will be ascertained, we will add the following text:
This paper presents a protocol for a scoping review which describes the progress of the implementation of the recommendations of the 2009 National Strategy for Antimicrobial Resistance in Ireland report. Papers or reports on AMS in Ireland will be mapped to the list of recommendations. These recommendations are detailed in the introduction.

The second objective of the scoping review is to identify ‘systems’ that facilitate or hinder the successful implementation of AMS guidelines. It would be clearer if the authors stated which models or theories the review will use to identify and categorize barriers and enablers to implementation. The authors use the word ‘systems’, but it is unclear whether they will include all domains of potential barriers and facilitators to AMS implementation or focus on only a few domains (e.g., focusing only on environmental context and resources, and behavioural regulation, but not collecting data on studies evaluating social influence on AMS).

Response: Thank you. Objective 2: We have reworded objective 2 to reflect that we are not engaging in a full review to find the barriers and facilitators of implementation. The new wording is as follows “To explore factors in the included studies that may have supported or hindered progress.”
The overall evidence will be mapped to four recommendation categories in the 2009 National Strategy for Antimicrobial Resistance in Ireland with a targeted summary of achievements and challenges per category.

In ‘Stage 5’, the authors state that they aim not to use a quality appraisal due to the broad nature of the research question. While this approach may be acceptable, it would still be beneficial to conduct a quality appraisal for any studies/literature that are possible and provide that information to the readers. For studies that cannot be appraised, they can be noted as ‘not applicable’ and provide reasons why it is not possible. This approach would allow readers to understand the quality of the studies included in the review. If none of the studies/literature being reviewed can be appraised for quality, it would still be helpful to provide individual reasons for each study/literature to the readers.

Response: Thank you.
While we agree, this is a scoping review and acceptable not to undertake a quality appraisal. However, we anticipate many of our sources will be from the grey literature and therefore not suitable for appraisal.
Thank you for reviewing this protocol. Please see the responses to your comments below:

The primary objective of the scoping review is to evaluate evidence of the 'progress' of AMS implementation. It would be clearer if the authors described potential indicators or outcomes, models or theories they will use to monitor the 'progress'. For example, will authors primarily use a set of structural indicators, process indicators and outcome indicators for AMS? or will they include other indicators to monitor the progress? Although the study aims to be broad due to the nature of the research question, providing a list of potential methods to be used could make the methods clearer and allow for replication by others.

Response: Thank you. To clarify how progress will be ascertained, we will add the following text:
This paper presents a protocol for a scoping review which describes the progress of the implementation of the recommendations of the 2009 National Strategy for Antimicrobial Resistance in Ireland report. Papers or reports on AMS in Ireland will be mapped to the list of recommendations. These recommendations are detailed in the introduction.

The second objective of the scoping review is to identify ‘systems’ that facilitate or hinder the successful implementation of AMS guidelines. It would be clearer if the authors stated which models or theories the review will use to identify and categorize barriers and enablers to implementation. The authors use the word ‘systems’, but it is unclear whether they will include all domains of potential barriers and facilitators to AMS implementation or focus on only a few domains (e.g., focusing only on environmental context and resources, and behavioural regulation, but not collecting data on studies evaluating social influence on AMS).

Response: Thank you. Objective 2: We have reworded objective 2 to reflect that we are not engaging in a full review to find the barriers and facilitators of implementation. The new wording is as follows “To explore factors in the included studies that may have supported or hindered progress.”
The overall evidence will be mapped to four recommendation categories in the 2009 National Strategy for Antimicrobial Resistance in Ireland with a targeted summary of achievements and challenges per category.

In ‘Stage 5’, the authors state that they aim not to use a quality appraisal due to the broad nature of the research question. While this approach may be acceptable, it would still be beneficial to conduct a quality appraisal for any studies/literature that are possible and provide that information to the readers. For studies that cannot be appraised, they can be noted as ‘not applicable’ and provide reasons why it is not possible. This approach would allow readers to understand the quality of the studies included in the review. If none of the studies/literature being reviewed can be appraised for quality, it would still be helpful to provide individual reasons for each study/literature to the readers.

Response: Thank you.
While we agree, this is a scoping review and acceptable not to undertake a quality appraisal. However, we anticipate many of our sources will be from the grey literature and therefore not suitable for appraisal.
Competing Interests: No competing interests were disclosed. Close
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Reviewer Report 28 Aug 2024

Michael J Durkin, Washington University School of Medicine, St. Louis, Missouri, USA

Approved with Reservations

https://doi.org/10.21956/hrbopenres.15266.r41979

This manuscript is a scoping review protocol to evaluate antimicrobial stewardship programs in Ireland between 2010 and 2021. The authors describe a detailed study protocol with sound methodology. I only have a few comments.

1) introduction 3rd paragraph last sentence. Reference 7 is listed at the beginning and end of the sentence.

2) This scoping review seems to focus on peer reviewed publications to evaluate the progress of antimicrobial stewardship programs in Ireland. Is this the best way to track progress in AMS implementation? In the US we will send out surveys to see if hospitals are meeting CDC recommendations. This may be an alternative approach to supplement published findings as well.

3) I like the research objectives. It would be nice to have a table or something that outlines what the guidelines have included in 2009. I imagine you all will want to see where places are falling short of the guidelines.

4) I like objective 2 as well. Some of the implementation science people will use the term facilitators and barriers to successful implementation of... You're probably looking at qualitative studies mostly here. Although I guess discussion sections of manuscripts will work well too. Again, this may also work well by being supplemented with additional survey or interview data. There might be reporting biases in publications with unsuccessful projects that may not have worked due to important barriers. These might be missed with a scoping review. Although this could also simply be discussed in the limitations section.

5) Grey literature search looks good. Do you think any additional information would be found on university/hospital websites as well?

6) Charting, collating, and summarizing the results sections look good.

7) The discussion section is very short. I have not reviewed a lot of study protocol manuscripts before. But it might be nice to describe what you hope to find, how the results would be helpful in more detail, and what you think the limitations would be with this approach. I would also be curious to see what you all think would be next steps afterwards. You could also state that this approach could be used as a template for other countries that might be interested in evaluating progress they have made with AMS after release of guidelines as well.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Antimicrobial stewardship, clinical research.

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Author Response 18 Dec 2024

Fiona Barry, School of Public Health, University College Cork, Cork, T12XF62, Ireland

18 Dec 2024

Author Response

Thank you for reviewing this protocol. Please see the responses to your comments below:
1) introduction 3rd paragraph last sentence. Reference 7 is listed at the beginning and end of ... Continue reading Thank you for reviewing this protocol. Please see the responses to your comments below:
1) introduction 3rd paragraph last sentence. Reference 7 is listed at the beginning and end of the sentence.
Response:
Thank you, the first reference will be deleted

2) This scoping review seems to focus on peer-reviewed publications to evaluate the progress of antimicrobial stewardship programs in Ireland. Is this the best way to track progress in AMS implementation? In the US, we will send out surveys to see if hospitals are meeting CDC recommendations. This may be an alternative approach to supplement published findings as well.
Response:
Thank you for your comment. We are also looking at the Grey literature in relation to identifying published evidence that actions have been taken and progress made. In addition, we plan, as a separate piece of work, to contact hospital and community-based antimicrobial pharmacists in Ireland to assess their views on the implementation of this strategy.

3) I like the research objectives. It would be nice to have a table or something that outlines what the guidelines have included in 2009. I imagine you all will want to see where places are falling short of the guidelines.
Response:
Thank you, a table outlining the guidelines will be added to Stage 4.

4) I like objective 2 as well. Some of the implementation science people will use the term facilitators and barriers to successful implementation of... You're probably looking at qualitative studies mostly here. Although I guess discussion sections of manuscripts will work well too. Again, this may also work well by being supplemented with additional survey or interview data. There might be reporting biases in publications with unsuccessful projects that may not have worked due to important barriers. These might be missed with a scoping review. Although this could also simply be discussed in the limitations section.
Response:
Thank you, this is one of the first papers in the overall research project. We will be collecting interview data in the next step. Bias will be addressed under limitations in the discussion section of the scoping review paper when published.

5) Grey literature search looks good. Do you think any additional information would be found on university/hospital websites as well?
Response:
Thank you, in Ireland hospitals/universities do not display this information on their websites.

6) Charting, collating, and summarizing the results sections look good.
Response:
Thank you.

7) The discussion section is very short. I have not reviewed a lot of study protocol manuscripts before. But it might be nice to describe what you hope to find, how the results would be helpful in more detail, and what you think the limitations would be with this approach. I would also be curious to see what you all think would be the next steps afterwards. You could also state that this approach could be used as a template for other countries that might be interested in evaluating the progress they have made with AMS after the release of guidelines as well.
Response:
Thank you we will add:
We will disseminate the findings through conferences, presentations, and peer-reviewed journals. These findings may inform future clinical practice and serve as a template for evaluating AMS progress at a national level, as well as for policy reform. The methodological approach may be useful in reviewing progress after the publication of AMS guidelines.
Thank you for reviewing this protocol. Please see the responses to your comments below:
1) introduction 3rd paragraph last sentence. Reference 7 is listed at the beginning and end of the sentence.
Response:
Thank you, the first reference will be deleted

2) This scoping review seems to focus on peer-reviewed publications to evaluate the progress of antimicrobial stewardship programs in Ireland. Is this the best way to track progress in AMS implementation? In the US, we will send out surveys to see if hospitals are meeting CDC recommendations. This may be an alternative approach to supplement published findings as well.
Response:
Thank you for your comment. We are also looking at the Grey literature in relation to identifying published evidence that actions have been taken and progress made. In addition, we plan, as a separate piece of work, to contact hospital and community-based antimicrobial pharmacists in Ireland to assess their views on the implementation of this strategy.

3) I like the research objectives. It would be nice to have a table or something that outlines what the guidelines have included in 2009. I imagine you all will want to see where places are falling short of the guidelines.
Response:
Thank you, a table outlining the guidelines will be added to Stage 4.

4) I like objective 2 as well. Some of the implementation science people will use the term facilitators and barriers to successful implementation of... You're probably looking at qualitative studies mostly here. Although I guess discussion sections of manuscripts will work well too. Again, this may also work well by being supplemented with additional survey or interview data. There might be reporting biases in publications with unsuccessful projects that may not have worked due to important barriers. These might be missed with a scoping review. Although this could also simply be discussed in the limitations section.
Response:
Thank you, this is one of the first papers in the overall research project. We will be collecting interview data in the next step. Bias will be addressed under limitations in the discussion section of the scoping review paper when published.

5) Grey literature search looks good. Do you think any additional information would be found on university/hospital websites as well?
Response:
Thank you, in Ireland hospitals/universities do not display this information on their websites.

6) Charting, collating, and summarizing the results sections look good.
Response:
Thank you.

7) The discussion section is very short. I have not reviewed a lot of study protocol manuscripts before. But it might be nice to describe what you hope to find, how the results would be helpful in more detail, and what you think the limitations would be with this approach. I would also be curious to see what you all think would be the next steps afterwards. You could also state that this approach could be used as a template for other countries that might be interested in evaluating the progress they have made with AMS after the release of guidelines as well.
Response:
Thank you we will add:
We will disseminate the findings through conferences, presentations, and peer-reviewed journals. These findings may inform future clinical practice and serve as a template for evaluating AMS progress at a national level, as well as for policy reform. The methodological approach may be useful in reviewing progress after the publication of AMS guidelines.
Competing Interests: No competing interests were disclosed. Close
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Respond or Comment

COMMENTS ON THIS REPORT

Author Response 18 Dec 2024

Fiona Barry, School of Public Health, University College Cork, Cork, T12XF62, Ireland

18 Dec 2024

Author Response

Thank you for reviewing this protocol. Please see the responses to your comments below:
1) introduction 3rd paragraph last sentence. Reference 7 is listed at the beginning and end of ... Continue reading Thank you for reviewing this protocol. Please see the responses to your comments below:
1) introduction 3rd paragraph last sentence. Reference 7 is listed at the beginning and end of the sentence.
Response:
Thank you, the first reference will be deleted

2) This scoping review seems to focus on peer-reviewed publications to evaluate the progress of antimicrobial stewardship programs in Ireland. Is this the best way to track progress in AMS implementation? In the US, we will send out surveys to see if hospitals are meeting CDC recommendations. This may be an alternative approach to supplement published findings as well.
Response:
Thank you for your comment. We are also looking at the Grey literature in relation to identifying published evidence that actions have been taken and progress made. In addition, we plan, as a separate piece of work, to contact hospital and community-based antimicrobial pharmacists in Ireland to assess their views on the implementation of this strategy.

3) I like the research objectives. It would be nice to have a table or something that outlines what the guidelines have included in 2009. I imagine you all will want to see where places are falling short of the guidelines.
Response:
Thank you, a table outlining the guidelines will be added to Stage 4.

4) I like objective 2 as well. Some of the implementation science people will use the term facilitators and barriers to successful implementation of... You're probably looking at qualitative studies mostly here. Although I guess discussion sections of manuscripts will work well too. Again, this may also work well by being supplemented with additional survey or interview data. There might be reporting biases in publications with unsuccessful projects that may not have worked due to important barriers. These might be missed with a scoping review. Although this could also simply be discussed in the limitations section.
Response:
Thank you, this is one of the first papers in the overall research project. We will be collecting interview data in the next step. Bias will be addressed under limitations in the discussion section of the scoping review paper when published.

5) Grey literature search looks good. Do you think any additional information would be found on university/hospital websites as well?
Response:
Thank you, in Ireland hospitals/universities do not display this information on their websites.

6) Charting, collating, and summarizing the results sections look good.
Response:
Thank you.

7) The discussion section is very short. I have not reviewed a lot of study protocol manuscripts before. But it might be nice to describe what you hope to find, how the results would be helpful in more detail, and what you think the limitations would be with this approach. I would also be curious to see what you all think would be the next steps afterwards. You could also state that this approach could be used as a template for other countries that might be interested in evaluating the progress they have made with AMS after the release of guidelines as well.
Response:
Thank you we will add:
We will disseminate the findings through conferences, presentations, and peer-reviewed journals. These findings may inform future clinical practice and serve as a template for evaluating AMS progress at a national level, as well as for policy reform. The methodological approach may be useful in reviewing progress after the publication of AMS guidelines.
Thank you for reviewing this protocol. Please see the responses to your comments below:
1) introduction 3rd paragraph last sentence. Reference 7 is listed at the beginning and end of the sentence.
Response:
Thank you, the first reference will be deleted

2) This scoping review seems to focus on peer-reviewed publications to evaluate the progress of antimicrobial stewardship programs in Ireland. Is this the best way to track progress in AMS implementation? In the US, we will send out surveys to see if hospitals are meeting CDC recommendations. This may be an alternative approach to supplement published findings as well.
Response:
Thank you for your comment. We are also looking at the Grey literature in relation to identifying published evidence that actions have been taken and progress made. In addition, we plan, as a separate piece of work, to contact hospital and community-based antimicrobial pharmacists in Ireland to assess their views on the implementation of this strategy.

3) I like the research objectives. It would be nice to have a table or something that outlines what the guidelines have included in 2009. I imagine you all will want to see where places are falling short of the guidelines.
Response:
Thank you, a table outlining the guidelines will be added to Stage 4.

4) I like objective 2 as well. Some of the implementation science people will use the term facilitators and barriers to successful implementation of... You're probably looking at qualitative studies mostly here. Although I guess discussion sections of manuscripts will work well too. Again, this may also work well by being supplemented with additional survey or interview data. There might be reporting biases in publications with unsuccessful projects that may not have worked due to important barriers. These might be missed with a scoping review. Although this could also simply be discussed in the limitations section.
Response:
Thank you, this is one of the first papers in the overall research project. We will be collecting interview data in the next step. Bias will be addressed under limitations in the discussion section of the scoping review paper when published.

5) Grey literature search looks good. Do you think any additional information would be found on university/hospital websites as well?
Response:
Thank you, in Ireland hospitals/universities do not display this information on their websites.

6) Charting, collating, and summarizing the results sections look good.
Response:
Thank you.

7) The discussion section is very short. I have not reviewed a lot of study protocol manuscripts before. But it might be nice to describe what you hope to find, how the results would be helpful in more detail, and what you think the limitations would be with this approach. I would also be curious to see what you all think would be the next steps afterwards. You could also state that this approach could be used as a template for other countries that might be interested in evaluating the progress they have made with AMS after the release of guidelines as well.
Response:
Thank you we will add:
We will disseminate the findings through conferences, presentations, and peer-reviewed journals. These findings may inform future clinical practice and serve as a template for evaluating AMS progress at a national level, as well as for policy reform. The methodological approach may be useful in reviewing progress after the publication of AMS guidelines.
Competing Interests: No competing interests were disclosed. Close
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Version 2

VERSION 2 PUBLISHED 31 Jul 2024

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Version 2 (revision) 24 Jan 25	read	read
Version 1 31 Jul 24	read	read

Michael J Durkin, Washington University School of Medicine, St. Louis, USA
Direk Limmathurotsakul, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand

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8 Views

18 Feb 2025 | for Version 2

Michael J Durkin, Washington University School of Medicine, St. Louis, Missouri, USA

8 Views Cite this report Responses(0)

Approved

Authors responded to comments. OK to index.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Antimicrobial stewardship, clinical research.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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7 Views

04 Feb 2025 | for Version 2

Direk Limmathurotsakul, Microbiology, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok / กรุงเทพมหานคร, Thailand

7 Views Cite this report Responses(0)

Approved

The authors have adequately responded to and revised the manuscript. I have no further comments.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Infectious Diseases, Tropical Infectious Diseases, Antimicrobial resistance

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

8 Views

28 Sep 2024 | for Version 1

Direk Limmathurotsakul, Microbiology, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok / กรุงเทพมหานคร, Thailand

8 Views Cite this report Responses(1)

Approved With Reservations

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Infectious Diseases, Tropical Infectious Diseases, Antimicrobial resistance

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Author Response

18 Dec 2024

Fiona Barry, School of Public Health, University College Cork, Cork, T12XF62, Ireland

Thank you for reviewing this protocol. Please see the responses to your comments below:

The primary objective of the scoping review is to evaluate evidence of the 'progress' of AMS implementation. It would be clearer if the authors described potential indicators or outcomes, models or theories they will use to monitor the 'progress'. For example, will authors primarily use a set of structural indicators, process indicators and outcome indicators for AMS? or will they include other indicators to monitor the progress? Although the study aims to be broad due to the nature of the research question, providing a list of potential methods to be used could make the methods clearer and allow for replication by others.

Response: Thank you. To clarify how progress will be ascertained, we will add the following text:
This paper presents a protocol for a scoping review which describes the progress of the implementation of the recommendations of the 2009 National Strategy for Antimicrobial Resistance in Ireland report. Papers or reports on AMS in Ireland will be mapped to the list of recommendations. These recommendations are detailed in the introduction.

The second objective of the scoping review is to identify ‘systems’ that facilitate or hinder the successful implementation of AMS guidelines. It would be clearer if the authors stated which models or theories the review will use to identify and categorize barriers and enablers to implementation. The authors use the word ‘systems’, but it is unclear whether they will include all domains of potential barriers and facilitators to AMS implementation or focus on only a few domains (e.g., focusing only on environmental context and resources, and behavioural regulation, but not collecting data on studies evaluating social influence on AMS).

Response: Thank you. Objective 2: We have reworded objective 2 to reflect that we are not engaging in a full review to find the barriers and facilitators of implementation. The new wording is as follows “To explore factors in the included studies that may have supported or hindered progress.”
The overall evidence will be mapped to four recommendation categories in the 2009 National Strategy for Antimicrobial Resistance in Ireland with a targeted summary of achievements and challenges per category.

In ‘Stage 5’, the authors state that they aim not to use a quality appraisal due to the broad nature of the research question. While this approach may be acceptable, it would still be beneficial to conduct a quality appraisal for any studies/literature that are possible and provide that information to the readers. For studies that cannot be appraised, they can be noted as ‘not applicable’ and provide reasons why it is not possible. This approach would allow readers to understand the quality of the studies included in the review. If none of the studies/literature being reviewed can be appraised for quality, it would still be helpful to provide individual reasons for each study/literature to the readers.

Response: Thank you.
While we agree, this is a scoping review and acceptable not to undertake a quality appraisal. However, we anticipate many of our sources will be from the grey literature and therefore not suitable for appraisal.

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

31 Views

28 Aug 2024 | for Version 1

Michael J Durkin, Washington University School of Medicine, St. Louis, Missouri, USA

31 Views Cite this report Responses(1)

Approved With Reservations

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Antimicrobial stewardship, clinical research.

Respond to this report

Responses (1)

Author Response

18 Dec 2024

Fiona Barry, School of Public Health, University College Cork, Cork, T12XF62, Ireland

Thank you for reviewing this protocol. Please see the responses to your comments below:
1) introduction 3rd paragraph last sentence. Reference 7 is listed at the beginning and end of the sentence.
Response:
Thank you, the first reference will be deleted

2) This scoping review seems to focus on peer-reviewed publications to evaluate the progress of antimicrobial stewardship programs in Ireland. Is this the best way to track progress in AMS implementation? In the US, we will send out surveys to see if hospitals are meeting CDC recommendations. This may be an alternative approach to supplement published findings as well.
Response:
Thank you for your comment. We are also looking at the Grey literature in relation to identifying published evidence that actions have been taken and progress made. In addition, we plan, as a separate piece of work, to contact hospital and community-based antimicrobial pharmacists in Ireland to assess their views on the implementation of this strategy.

3) I like the research objectives. It would be nice to have a table or something that outlines what the guidelines have included in 2009. I imagine you all will want to see where places are falling short of the guidelines.
Response:
Thank you, a table outlining the guidelines will be added to Stage 4.

4) I like objective 2 as well. Some of the implementation science people will use the term facilitators and barriers to successful implementation of... You're probably looking at qualitative studies mostly here. Although I guess discussion sections of manuscripts will work well too. Again, this may also work well by being supplemented with additional survey or interview data. There might be reporting biases in publications with unsuccessful projects that may not have worked due to important barriers. These might be missed with a scoping review. Although this could also simply be discussed in the limitations section.
Response:
Thank you, this is one of the first papers in the overall research project. We will be collecting interview data in the next step. Bias will be addressed under limitations in the discussion section of the scoping review paper when published.

5) Grey literature search looks good. Do you think any additional information would be found on university/hospital websites as well?
Response:
Thank you, in Ireland hospitals/universities do not display this information on their websites.

6) Charting, collating, and summarizing the results sections look good.
Response:
Thank you.

7) The discussion section is very short. I have not reviewed a lot of study protocol manuscripts before. But it might be nice to describe what you hope to find, how the results would be helpful in more detail, and what you think the limitations would be with this approach. I would also be curious to see what you all think would be the next steps afterwards. You could also state that this approach could be used as a template for other countries that might be interested in evaluating the progress they have made with AMS after the release of guidelines as well.
Response:
Thank you we will add:
We will disseminate the findings through conferences, presentations, and peer-reviewed journals. These findings may inform future clinical practice and serve as a template for evaluating AMS progress at a national level, as well as for policy reform. The methodological approach may be useful in reviewing progress after the publication of AMS guidelines.

View more View less

Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

[1] 1. World Health Organization: Antimicrobial Resistance. Geneva: Key Facts. 2018; (accessed June 06, 2024). Reference Source

[2] 2. European Centre for Disease Prevention and Control (ECDC): European Antimicrobial Resistance Surveillance Network (EARS-Net). Reference Source

[3] 3. Darby EM, Trampari E, Siasat P, et al.: Molecular mechanisms of antibiotic resistance revisited. Nat Rev Microbiol. 2023; 21(5): 280–95. PubMed Abstract | Publisher Full Text

[4] 4. Aryee A, Price N: Antimicrobial Stewardship - can we afford to do without it? Br J Clin Pharmacol. 2015; 79(2): 173–81. PubMed Abstract | Publisher Full Text | Free Full Text

[5] 5. Ohl CA, Luther VP: Antimicrobial Stewardship for inpatient facilities. J Hosp Med. 2011; 6(S1): S4–15. PubMed Abstract | Publisher Full Text

[6] 6. National Disease Surveillance Centre: SARI. A strategy for the control of Antimicrobial Resistance in Ireland. Report of the subgroup of the scientific advisory committee of the National Disease Surveillance Centre. NDSC, 2001. Reference Source

[7] 7. Health Protection Surveillance Centre: SARI Hospital Antimicrobial Stewardship Working Group: Guidelines for Antimicrobial Stewardship in hospitals in Ireland. Dublin: Health Protection Surveillance Centre, 2009. Reference Source

[8] 8. Peters MDJ, Marnie C, Tricco AC, et al.: Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020; 18(10): 2119–2126. PubMed Abstract | Publisher Full Text

[9] 9. Peters MDJ, Godfrey C, McInerney P, et al.: Best practice guidance and reporting items for the development of scoping review protocols. JBI Evid Synth. 2022; 20(4): 953–968. PubMed Abstract | Publisher Full Text

[10] 10. Levac D, Colquhoun H, O'Brien KK: Scoping studies: advancing the methodology. Implement Sci. 2010; 5: 69. PubMed Abstract | Publisher Full Text | Free Full Text

[11] 11. Mendeley—reference management software & researcher network. [cited 2024 June 06]. Reference Source

[12] 12. Covidence systematic review software. Veritas Health Innovation, Melbourne, Australia.

[13] 13. Microsoft Corporation: Microsoft excel. 2018. Reference Source

[14] 14. Tricco AC, Lillie E, Zarin W, et al.: PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169(7): 467–73. PubMed Abstract | Publisher Full Text

Antimicrobial Stewardship in Ireland (2010-2021): a scoping review protocol

Abstract

Background

Methods

Results

Conclusion

Keywords

Introduction

Study rationale

Dissemination

Methods

Stage 1: Identifying the research question

Stage 2: Identifying the relevant studies

Stage 3: Study selection

Stage 4: Charting the data

Stage 5: Collating, summarising, reporting the results

Discussion

Ethics and consent

Data availability

Acknowledgements

References

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Antimicrobial Stewardship in Ireland (2010-2021): a scoping review protocol

Abstract

Background

Methods

Results

Conclusion

Keywords

Introduction

Study rationale

Dissemination

Methods

Stage 1: Identifying the research question

Stage 2: Identifying the relevant studies

Stage 3: Study selection

Stage 4: Charting the data

Stage 5: Collating, summarising, reporting the results

Discussion

Ethics and consent

Data availability

Acknowledgements

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Competing Interests Policy

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Are you a HRB-funded researcher?

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