Background Antimicrobial Stewardship (AMS) has been in existence since the early 1990s.
Purpose To measure the extent and components of global efforts in AMS.
Materials and Methods A 43-question survey was developed and tested using robust survey methodology, then refined – piloting in 11 countries across 6 continents – and disseminated worldwide.
Results Responses from the UK: 109 England, 10 Scotland, 9 Wales & 3 Northern Ireland. Within the UK, 101 (79%) have an Antimicrobial Stewardship Programme (ASP). The main barriers are lack of information technology and lack of personnel. In the 22 (17%) that plan to develop an ASP the main barrier is lack of funding. Main ASP objectives were to reduce healthcare-acquired infection (91%), improve outcomes (57%), resistance (47%) and reduce prescribing (46%). 70% have an AMS policy, 92% a formulary, 88% specific treatment and 83% prophylaxis guidance for all areas. AMS rounds exist in 86%, resulting in reductions of antimicrobial (ATM) use in 36%, increases in 14% and no change in 50%.
Restriction of some ATMs occurs in 92% of hospitals: 84% restrict carbapenems, 88% quinolones, 91% cephalosporins. In 64% the pharmacy follows up. 12% practise diversity of ATMs and 5% cycle ATMs. 92% of ASPs report antimicrobial usage; 31% link these data to resistance rates and 33% to infection rates. Only 6% have electronic prescribing for all patients.
The intranet is the most common communication method, followed by credit card, booklet, poster then smartphone app. All educate staff, mainly by with face to face induction followed by written information.
Of the 33% who have formally reviewed their ASP, 100% (15) showed reduction in inappropriate prescribing, 76% (19) in broad spectrum antibiotics use, 71% (15) in expenditure, 91% (21) in healthcare-associated infections, 50% (3) in length of stay & 54% (7) in resistance.
Conclusions Despite inherent limitations (e.g. response bias, unselected institutions, etc.), this survey suggests AMS can reduce antimicrobial resistance and expenditure, and should encourage a strategy to promote worldwide ASPs.
No conflict of interest.
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