Background Antimicrobial stewardship (AMS) has been surveyed at national and continental level, but never at a global level. The European Society of Clinical Microbiology & Infectious Diseases, Guidelines & Policies Working Group (ESGAP) supported a worldwide survey of AMS. This aimed to quantify the delivery & impact of AMS across the world.

Purpose A literature review identified published surveys and standards for AMS. The survey aimed to quantify those aspects of AMS that were being delivered; the barriers to delivery; funding & staffing of AMS; and its impact on financial, safety and resistance outcomes.

Materials and Methods This was an open web-based survey of hospitals via SurveyMonkey software using good practise methodology. It was piloted in 11 countries in 6 continents, refined, then disseminated through microbiology, infectious diseases and pharmacy networks & websites.

Results By the initial deadline, 513 hospitals worldwide & 298 from Europe (including 122 from the United Kingdom (UK)) had entered data.

26 non-UK European countries entered data (range: 1 (many) to 24 (France); average 7; mean 3). 65% of hospitals had AMS standards & 19% were planning them. 74% had an AMS Committee, 58% had an AMS Programme in place & 25% had one planned. Lack of information technology was the main barrier. Antimicrobial or infectious diseases pharmacists were present on 86% of AMS committees. On average, there was 8 hours per week of pharmacist time for AMS from the 75 responses. 80% had an antimicrobial formulary, 69% guidelines, 58% restriction, 40% day 3 review, 50% IV-to-oral switch guidance & 57% had dose optimisation on request. 61% had AMS ward rounds mainly on intensive care & medicine. 34 centres had formally assessed their AMS programmes and had demonstrated reductions in expenditure, broad spectrum & inappropriate prescribing, but no decrease in length of stay or reduction in antimicrobial resistance.

Conclusions AMS appears to be well developed in many parts of Europe, and pharmacists are actively involved in its delivery.

No conflict of interest.