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J Antimicrob Chemother. 2015 Apr;70(4):1245-55. doi: 10.1093/jac/dku497. Epub 2014 Dec 18.

An international cross-sectional survey of antimicrobial stewardship programmes in hospitals.

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Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
CHU de Nancy, Service de Maladies Infectieuses, Nancy, France Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, Nancy, France.
Infectious Diseases Unit, Hospital Carlos G Durand, Buenos Aires, Argentina.
Leeds Institute for Health Sciences, University of Leeds, Leeds LS2 9LJ, UK.
Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK.
Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.



To report the extent and components of global efforts in antimicrobial stewardship (AMS) in hospitals.


An Internet-based survey comprising 43 questions was disseminated worldwide in 2012.


Responses were received from 660 hospitals in 67 countries: Africa, 44; Asia, 50; Europe, 361; North America, 72; Oceania, 30; and South and Central America, 103. National AMS standards existed in 52% of countries, 4% were planning them and 58% had an AMS programme. The main barriers to implementing AMS programmes were perceived to be a lack of funding or personnel, a lack of information technology and prescriber opposition. In hospitals with an existing AMS programme, AMS rounds existed in 64%; 81% restricted antimicrobials (carbapenems, 74.3%; quinolones, 64%; and cephalosporins, 58%); and 85% reported antimicrobial usage, with 55% linking data to resistance rates and 49% linking data to infection rates. Only 20% had electronic prescribing for all patients. A total of 89% of programmes educated their medical, nursing and pharmacy staff on AMS. Of the hospitals, 38% had formally reviewed their AMS programme: reductions were reported by 96% of hospitals for inappropriate prescribing, 86% for broad-spectrum antibiotic use, 80% for expenditure, 71% for healthcare-acquired infections, 65% for length of stay or mortality and 58% for bacterial resistance.


The worldwide development and implementation of AMS programmes varies considerably. Our results should inform and encourage the further evaluation of this with a view to promoting a worldwide stewardship framework. The prospective measurement of well-defined outcomes of the impact of these programmes remains a significant challenge.


antibiotic management; antibiotic policy; antibiotic prescription

[Indexed for MEDLINE]

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