United Nations AMR action: development and early validation of a real-time, dual-phase antimicrobial stewardship dashboard for full-pathway monitoring of empirical and subsequent antibiotic therapy

Background: Antimicrobial resistance (AMR) is a major global health challenge, causing an estimated 1.27 million deaths in 2019 and projected to contribute to 10 million deaths annually by 2050. Strengthening antimicrobial stewardship (AMS) is critical to addressing this threat. However, stewardship monitoring systems remain fragmented and retrospective, limiting timely action. The COVID-19 pandemic further exposed these limitations, highlighting the need for innovative, accessible, real-time solutions to improve stewardship and patient safety. Methods: A four-phase methodology was employed. Phase 1 comprised a systematic review of antimicrobial stewardship strategies before and during the COVID-19 pandemic. Phase 2 involved retrospective analysis of 640 patient records, while Phase 3 surveyed 240 healthcare professionals regarding AMS knowledge, attitudes and practices. Phase 4 focused on user-centred dashboard development. Validation incorporated technical testing, expert review, and patient and public involvement to assess accuracy, usability and feasibility. Results: The dashboard enables dual-phase monitoring of empirical prescribing and subsequent antibiotic therapy across the antimicrobial pathway. Features include real-time visualisation, interactive filtering by temporal, spatial and clinical variables, and ward-level monitoring to support quality improvement. Early validation demonstrated high concordance between source data and dashboard outputs, responsive performance under simulated load, and favourable expert assessments of usability, clinical relevance, feasibility and operational resilience. Conclusions: This innovative AMS dashboard shifts stewardship from retrospective audit to proactive decision support. Its low-infrastructure, dual-phase design offers sustainability within the NHS and scalability across healthcare settings, supporting global AMR action and the achievement of Sustainable Development Goals.