{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:44:59Z","timestamp":1785930299172,"version":"3.56.0"},"reference-count":49,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Antimicrobial stewardship programmes (ASPs) are essential for improving antimicrobial use and limiting the emergence of antimicrobial resistance. Although national ASP key performance indicators (KPIs) have been implemented across Saudi Ministry of Health (MOH) hospitals, large-scale evaluations of programme performance remain limited. This study evaluated national ASP performance across MOH hospitals from 2021 to 2024 using formal KPIs and complementary stewardship measures. Methods: This retrospective multicentre surveillance analysis included 124,452 antimicrobial prescription reviews from 96 Saudi MOH hospitals actively reporting stewardship activities. Hospitals were classified according to ASP capacity as category A, B, or C. The evaluated KPIs included protocol adherence, restricted-antibiotic dispensing compliance, active intervention rate, annual trends in optimization interventions, and physician acceptance of ASP recommendations. Secondary assessments included appropriateness of therapy management, therapeutic drug monitoring (TDM) for vancomycin and aminoglycosides, and hospital-level antimicrobial use expressed as defined daily doses per 100 available bed-days. Multivariable logistic regression was used to identify factors associated with guideline non-adherence and physician non-acceptance. Results: Overall protocol adherence was 87.1%, exceeding the national target of 80%, while the active intervention rate was 64.6%, exceeding the 60% benchmark. Restricted-antibiotic dispensing compliance reached 87.6% but remained below the 100% target. Physician acceptance of ASP recommendations was high at 93.0%, although it did not achieve the national target of 98%. The optimization-intervention KPI was not met because de-escalation, antibiotic discontinuation, and intravenous-to-oral conversion did not demonstrate a sustained annual increase. Appropriate ongoing therapy management was documented in 68.3% of cases with available data, whereas TDM was requested in 44.5% of eligible vancomycin or aminoglycoside cases. Antimicrobial use varied across years and hospital categories, with higher monitored broad-spectrum and reserve-agent use in higher-capacity hospitals. Lower ASP capacity, non-critical care settings, and combination therapy were consistently associated with less favourable stewardship outcomes. Conclusions: Saudi MOH hospitals actively reporting stewardship activities demonstrated favourable performance in protocol adherence, intervention activity, and physician acceptance. However, persistent gaps in restricted-antibiotic dispensing, optimization interventions, TDM, and inter-hospital variation indicate the need for continued strengthening of ASP infrastructure, monitoring, and feedback systems. Future research should link stewardship indicators with clinical outcomes, antimicrobial resistance trends, and patient safety.<\/jats:p>","DOI":"10.3390\/antibiotics15080753","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T15:08:09Z","timestamp":1785856089000},"page":"753","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["National Antimicrobial Stewardship Performance and Antimicrobial Use in Saudi Ministry of Health Hospitals: A Four-Year Multicenter Surveillance Analysis, 2021\u20132024"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7975-933X","authenticated-orcid":false,"given":"Saleh","family":"Alghamdi","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Pharmacy, Al-Baha University, Al-Baha 65779, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Algarni","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Pharmacy, Al-Baha University, Al-Baha 65779, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa","family":"Mutlaq","sequence":"additional","affiliation":[{"name":"General Administration of Pharmaceutical Care, Ministry of Health, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6964-2740","authenticated-orcid":false,"given":"Reema","family":"Almuraybidh","sequence":"additional","affiliation":[{"name":"General Administration of Pharmaceutical Care, Ministry of Health, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nawal","family":"Alfardus","sequence":"additional","affiliation":[{"name":"General Administration of Pharmaceutical Care, Ministry of Health, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumaiah","family":"Aljudaibi","sequence":"additional","affiliation":[{"name":"Hospital Support Operations Centre, Ministry of Health, Riyadh 11176, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amnah","family":"Aljaffar","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Care, Dammam Medical Complex, Eastern Health Cluster, Dammam 32253, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3168-4156","authenticated-orcid":false,"given":"Ahmed","family":"Alghamdi","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salman","family":"Alghamdi","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Care, Almikwah Hospital, Al-Baha Health Cluster, Ministry of Health, Al-Baha 65784, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9994-7266","authenticated-orcid":false,"given":"Abdullah S.","family":"Alshammari","sequence":"additional","affiliation":[{"name":"Pharmaceutical Practices Department, College of Pharmacy, Umm Al-Qura University, Makkah 24237, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulhakim A.","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Care, King Fahad Hospital, Al-Baha Health Cluster, Ministry of Health, Al-Baha 57911, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1800-5814","authenticated-orcid":false,"given":"Bassant Mohamed","family":"Barakat","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Pharmacy, Al-Baha University, Al-Baha 65779, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4753-5411","authenticated-orcid":false,"given":"Mohammad A.","family":"Albanghali","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 57911, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.4065\/mcp.2011.0358","article-title":"Antimicrobial Stewardship","volume":"86","author":"Doron","year":"2011","journal-title":"Mayo Clin. Proc."},{"key":"ref_2","unstructured":"World Health Organization (2021). 2020 Antibacterial Agents in Clinical and Preclinical Development: An Overview and Analysis, WHO. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240021303."},{"key":"ref_3","unstructured":"Shrestha, J., Zahra, F., and Cannady, J.P. (2025, August 23). Antimicrobial Stewardship, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK572068\/."},{"key":"ref_4","unstructured":"World Health Organization (2015). Global Action Plan on Antimicrobial Resistance, World Health Organization."},{"key":"ref_5","unstructured":"United Nations General Assembly (2016). Political Declaration of the High-Level Meeting of the General Assembly on Antimicrobial Resistance, United Nations. Resolution A\/RES\/71\/3."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"ref_7","unstructured":"O\u2019Neill, J. (2016). Tackling Drug-Resistant Infections Globally: Final Report and Recommendations, The Review on Antimicrobial Resistance."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1001\/archinte.163.8.972","article-title":"Unnecessary Use of Antimicrobials in Hospitalized Patients","volume":"163","author":"Hecker","year":"2003","journal-title":"Arch. Intern. Med."},{"key":"ref_9","unstructured":"O\u2019Neill, J. (2014). Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations, The Review on Antimicrobial Resistance."},{"key":"ref_10","unstructured":"World Bank (2017). Drug-Resistant Infections: A Threat to Our Economic Future, World Bank."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Liu, C., Liu, C., Wang, D., and Zhang, X. (2019). Knowledge, Attitudes and Intentions to Prescribe Antibiotics: A Structural Equation Modeling Study of Primary Care Institutions in Hubei, China. Int. J. Environ. Res. Public Health, 16.","DOI":"10.21203\/rs.2.10397\/v1"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"dlab038","DOI":"10.1093\/jacamr\/dlab038","article-title":"The potential impact of the COVID-19 pandemic on global antimicrobial and biocide resistance: An AMR Insights global perspective","volume":"3","author":"Ansari","year":"2021","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"E3463","DOI":"10.1073\/pnas.1717295115","article-title":"Global increase and geographic convergence in antibiotic consumption between 2000 and 2015","volume":"115","author":"Klein","year":"2018","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/S0140-6736(15)00474-2","article-title":"Access to effective antimicrobials: A worldwide challenge","volume":"387","author":"Laxminarayan","year":"2016","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1111\/nyas.14677","article-title":"Determinants associated with doctors\u2019 prescribing behaviors in public hospitals in China","volume":"1507","author":"Pan","year":"2022","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_16","unstructured":"Institute for Health Metrics and Evaluation (2025). The Burden of Antimicrobial Resistance (AMR) in Saudi Arabia, Institute for Health Metrics and Evaluation."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Haseeb, A., Faidah, H.S., Algethamy, M., Alghamdi, S., Alhazmi, G.A., Alshomrani, A.O., Alqethami, B.R., Alotibi, H.S., Almutiri, M.Z., and Almuqati, K.S. (2021). Antimicrobial Usage and Resistance in Makkah Region Hospitals: A Regional Point Prevalence Survey of Public Hospitals. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19010254"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1086\/510393","article-title":"Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship","volume":"44","author":"Dellit","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1016\/j.dld.2016.06.023","article-title":"Antimicrobial stewardship in a Gastroenterology Department: Impact on antimicrobial consumption, antimicrobial resistance and clinical outcome","volume":"48","author":"Bedini","year":"2016","journal-title":"Dig. Liver Dis."},{"key":"ref_20","first-page":"403","article-title":"The Search for Good Antimicrobial Stewardship","volume":"27","author":"Gerding","year":"2001","journal-title":"Jt. Comm. J. Qual. Improv."},{"key":"ref_21","first-page":"CD003543","article-title":"Interventions to improve antibiotic prescribing practices for hospital inpatients","volume":"2","author":"Davey","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1128\/CMR.18.4.638-656.2005","article-title":"Antimicrobial Stewardship Programs in Health Care Systems","volume":"18","author":"MacDougall","year":"2005","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/S1473-3099(16)00065-7","article-title":"Current evidence on hospital antimicrobial stewardship objectives: A systematic review and meta-analysis","volume":"16","author":"Schuts","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4840","DOI":"10.1128\/AAC.00825-16","article-title":"Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs","volume":"60","author":"Karanika","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1093\/cid\/ciw118","article-title":"Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America","volume":"62","author":"Barlam","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e20","DOI":"10.1017\/ash.2021.180","article-title":"The state of antibiotic stewardship programs in 2021: The perspective of an experienced steward","volume":"1","author":"Barlam","year":"2021","journal-title":"Antimicrob. Steward. Healthc. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Alghamdi, S., Berrou, I., Aslanpour, Z., Mutlaq, A., Haseeb, A., Albanghali, M., Hammad, M.A., and Shebl, N. (2021). Antimicrobial Stewardship Programmes in Saudi Hospitals: Evidence from a National Survey. Antibiotics, 10.","DOI":"10.3390\/antibiotics10020193"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e619","DOI":"10.1016\/S2214-109X(18)30186-4","article-title":"Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: Results of an internet-based global point prevalence survey","volume":"6","author":"Versporten","year":"2018","journal-title":"Lancet Glob. Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2146\/ajhp120568","article-title":"Clinical practice guidelines for antimicrobial prophylaxis in surgery","volume":"70","author":"Bratzler","year":"2013","journal-title":"Am. J. Health Syst. Pharm."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.3855\/jidc.6731","article-title":"Antibiotics in surgical wards: Use or misuse? A newly industrialized country\u2019s perspective","volume":"9","author":"Lim","year":"2015","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_31","unstructured":"Centers for Disease Control and Prevention (2019). The Core Elements of Hospital Antibiotic Stewardship Programs: 2019."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"6663119","DOI":"10.1155\/2024\/6663119","article-title":"Evaluating Antibiotic Treatment Guideline Adherence to Ongoing Antibiotic Stewardship in a Tertiary Care Setting: A Retrospective Observational Study","volume":"2024","author":"Pant","year":"2024","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Biniek, J.P., Schwab, F., Graf, K., and Vonberg, R.P. (2024). Adherence to Antibiotic Prescription Guidelines in Four Community Hospitals in Germany. Antibiotics, 13.","DOI":"10.3390\/antibiotics13070635"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Charani, E., Smith, I., Skodvin, B., Perozziello, A., Lucet, J.C., Lescure, F.X., Birgand, G., Poda, A., Ahmad, R., and Singh, S. (2019). Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries, A qualitative study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0209847"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1111\/bcp.13486","article-title":"Impact of antimicrobial stewardship programme on hospitalized patients at the intensive care unit: A prospective audit and feedback study","volume":"84","author":"Khdour","year":"2018","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"4301","DOI":"10.2147\/IDR.S532011","article-title":"Impact of Multidisciplinary Collaboration on Microbiological Specimen Submission and Appropriate Use of Carbapenems: A Pre-Post Cohort Study","volume":"18","author":"Zou","year":"2025","journal-title":"Infect. Drug Resist."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.cmi.2017.08.026","article-title":"What is antimicrobial stewardship?","volume":"23","author":"Dyar","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Khan, S., Bond, S.E., Bakhit, M., Hasan, S.S., Sadeq, A.A., Conway, B.R., and Aldeyab, M.A. (2022). COVID-19 Mixed Impact on Hospital Antimicrobial Stewardship Activities: A Qualitative Study in UK-Based Hospitals. Antibiotics, 11.","DOI":"10.3390\/antibiotics11111600"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Ashiru-Oredope, D., Kerr, F., Hughes, S., Urch, J., Lanzman, M., Yau, T., Cockburn, A., Patel, R., Sheikh, A., and Gormley, C. (2021). Assessing the Impact of COVID-19 on Antimicrobial Stewardship Activities\/Programs in the United Kingdom. Antibiotics, 10.","DOI":"10.3390\/antibiotics10020110"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1016\/j.cmi.2020.07.048","article-title":"Antibiotics: Easier to start than to stop? Predictors of antimicrobial stewardship recommendation acceptance","volume":"26","author":"Langford","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"ofac458","DOI":"10.1093\/ofid\/ofac458","article-title":"Factors Associated with Acceptance of Telehealth-Based Antimicrobial Stewardship Program Recommendations in a Community Hospital Health System","volume":"9","author":"Shively","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/CCM.0000000000004698","article-title":"Long-Term Sustainability and Acceptance of Antimicrobial Stewardship in Intensive Care: A Retrospective Cohort Study*","volume":"49","author":"Sehgal","year":"2021","journal-title":"Crit. Care Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1093\/ajhp\/zxaa036","article-title":"Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists","volume":"77","author":"Rybak","year":"2020","journal-title":"Am. J. Health-Syst. Pharm."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Tsutsuura, M., Moriyama, H., Kojima, N., Mizukami, Y., Tashiro, S., Osa, S., Enoki, Y., Taguchi, K., Oda, K., and Fujii, S. (2021). The monitoring of vancomycin: A systematic review and meta-analyses of area under the concentration-time curve-guided dosing and trough-guided dosing. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-05858-6"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Ye, Z.K., Tang, H.L., and Zhai, S.D. (2013). Benefits of Therapeutic Drug Monitoring of Vancomycin: A Systematic Review and Meta-Analysis. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0077169"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.jiph.2022.04.007","article-title":"Vancomycin Therapeutic Drug Monitoring (TDM) and Its Association with Clinical Outcomes: A Retrospective Cohort","volume":"15","year":"2022","journal-title":"J. Infect. Public Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/s13756-020-00751-4","article-title":"The impact of antimicrobial stewardship program implementation at four tertiary private hospitals: Results of a five-years pre-post analysis","volume":"9","author":"Alhumaid","year":"2020","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/j.ijid.2021.03.035","article-title":"A systematic review of Antimicrobial Stewardship Program implementation in Middle Eastern countries","volume":"105","author":"Ababneh","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e2253806","DOI":"10.1001\/jamanetworkopen.2022.53806","article-title":"Association Between Antimicrobial Stewardship Programs and Antibiotic Use Globally","volume":"6","author":"Win","year":"2023","journal-title":"JAMA Netw. Open"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/8\/753\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T10:54:01Z","timestamp":1785927241000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/8\/753"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":49,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["antibiotics15080753"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15080753","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}