Optimising antimicrobial stewardship (AMS) outcomes in Australia through improved vaccination uptake

Abstract

Antimicrobial resistance (AMR), a leading global health threat, is projected to cause 10 million deaths annually by 2050 without effective intervention. Vaccines are among the most impactful public health tools, preventing millions of infections and reducing inappropriate antimicrobial use. However, their role within antimicrobial stewardship (AMS) programs remains underutilised. This thesis systematically evaluated the contribution of vaccines to AMS and examined factors influencing vaccine confidence and uptake in both hospital and general public settings, to inform AMS strategies aimed at reducing AMR and improving outcomes.

A scoping review of 34 articles identified vaccines as a justified component of AMS, most commonly through education, screening, vaccination delivery, and monitoring, though evidence of implementation was limited beyond influenza and pneumococcal vaccines. Two cross-sectional surveys explored determinants of COVID-19 vaccine confidence and uptake among Australian adults. Among 1,053 hospital-vaccinated respondents, trust in government health websites was positively associated with confidence (OR 1.43), while exposure to misinformation reduced it (OR 0.71). In a general public sample (n=471), reliance on official sources and general practitioners increased confidence and vaccination likelihood up to eight-fold, whereas non-mainstream media use decreased both (~60% reduction).

Building on these findings, a targeted AMS intervention is proposed to promote uptake of recommended vaccines—including COVID-19, RSV, and herpes zoster—among immunocompromised patients in specialised hospital units. This intervention incorporates educational models to address confidence barriers and recommends monitoring metrics such as vaccine coverage, infection-related readmissions, and antimicrobial use. Together, the work demonstrates the value of integrating vaccines into AMS, informed by behavioural and contextual factors, to combat AMR and enhance public health.