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

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


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

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

Results: 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.

Conclusions: 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.

Keywords: antibiotic management; antibiotic policy; antibiotic prescription.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Cross-Sectional Studies
  • Drug Prescriptions / standards*
  • Drug Utilization / standards*
  • Global Health
  • Health Services Research
  • Hospitals*
  • Humans
  • Organizational Policy


  • Anti-Bacterial Agents