Nationwide multicenter questionnaire surveys on countermeasures against antimicrobial resistance and infections in hospitals

BMC Infect Dis. 2021 Feb 27;21(1):234. doi: 10.1186/s12879-021-05921-2.


Background: The goals of the National Action Plan on Antimicrobial Resistance (AMR) of Japan include "implementing appropriate infection prevention and control" and "appropriate use of antimicrobials," which are relevant to healthcare facilities. Specifically, linking efforts between existing infection control teams and antimicrobial stewardship programs was suggested to be important. Previous studies reported that human resources, such as full-time equivalents of infection control practitioners, were related to improvements in antimicrobial stewardship.

Methods: We posted questionnaires to all teaching hospitals (n = 1017) regarding hospital countermeasures against AMR and infections. To evaluate changes over time, surveys were conducted twice (1st survey: Nov 2016, 2nd survey: Feb 2018). A latent transition analysis (LTA) was performed to identify latent statuses, which refer to underlying subgroups of hospitals, and effects of the number of members in infection control teams per bed on being in the better statuses.

Results: The number of valid responses was 678 (response rate, 66.7%) for the 1st survey and 559 (55.0%) for the 2nd survey. More than 99% of participating hospitals had infection control teams, with differences in activity among hospitals. Roughly 70% had their own intervention criteria for antibiotics therapies, whereas only about 60 and 50% had criteria established for the use of anti-methicillin-resistant Staphylococcus aureus antibiotics and broad-spectrum antibiotics, respectively. Only 50 and 40% of hospitals conducted surveillance of catheter-associated urinary tract infections and ventilator-associated pneumonia, respectively. Less than 50% of hospitals used maximal barrier precautions for central line catheter insertion. The LTA identified five latent statuses. The membership probability of the most favorable status in the 2nd study period was slightly increased from the 1st study period (23.6 to 25.3%). However, the increase in the least favorable status was higher (26.3 to 31.8%). Results of the LTA did not support a relationship between increasing the number of infection control practitioners per bed, which is reportedly related to improvements in antimicrobial stewardship, and being in more favorable latent statuses.

Conclusions: Our results suggest the need for more comprehensive antimicrobial stewardship programs and increased surveillance activities for healthcare-associated infections to improve antimicrobial stewardship and infection control in hospitals.

Keywords: Antimicrobial resistance; Antimicrobial stewardship; Healthcare-associated infection; Infection control; Surveillance.

Publication types

  • Multicenter Study

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Anti-Infective Agents / therapeutic use*
  • Antimicrobial Stewardship / methods*
  • Antimicrobial Stewardship / standards
  • Catheter-Related Infections / drug therapy
  • Catheter-Related Infections / epidemiology
  • Catheter-Related Infections / prevention & control
  • Cross Infection / drug therapy*
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control*
  • Drug Resistance, Bacterial*
  • Hand Hygiene / standards
  • Hand Hygiene / statistics & numerical data
  • Health Knowledge, Attitudes, Practice
  • Hospitals, Teaching* / standards
  • Hospitals, Teaching* / statistics & numerical data
  • Humans
  • Infection Control / methods
  • Infection Control / standards
  • Japan / epidemiology
  • Personnel, Hospital / statistics & numerical data
  • Pneumonia, Ventilator-Associated / drug therapy
  • Pneumonia, Ventilator-Associated / epidemiology
  • Pneumonia, Ventilator-Associated / prevention & control
  • Practice Patterns, Physicians' / standards
  • Surveys and Questionnaires


  • Anti-Bacterial Agents
  • Anti-Infective Agents