title: Antibiotic stewardship in Germany: a cross-sectional questionnaire survey of 355 intensive care units.
abstract: OBJECTIVE
  Little information is available on antibiotic prescription management in German hospitals. The objective of this cross-sectional study was to determine the prevalence and components of antibiotic stewardship measures in German intensive care units (ICUs).
  
  
  METHODS
  A questionnaire survey was sent to all ICUs participating in the German nosocomial infection surveillance system (n = 579) in October 2011. Data on antibiotic management structures were collected and analyzed by structural hospital and ICU factors.
  
  
  RESULTS
  The questionnaire was completed by 355 German ICUs (response rate 61 %). Common measures used (>80 % of the ICUs) were personnel restrictions for antibiotic prescriptions, routine access to bacterial resistance data, and pharmacy reports on antibiotic costs and consumption. A small proportion of ICUs (14 %) employed physicians specialized in the prescription of antimicrobial medication. Hospitals with their own microbiological laboratory report participation in surveillance networks for antimicrobial use (34 %) and bacterial resistance (32 %) twice as often as hospitals with external laboratories (15 and 14 %, respectively, p < 0.001). Also, non-profit and public hospitals participate more often in surveillance networks for bacterial resistance than private hospitals (>23 % vs. 11 %, p < 0.05).
  
  
  CONCLUSIONS
  While the majority of ICUs report to have some antibiotic policies established, the contents and composition of these policies vary. Organizational-level control strategies to improve antibiotic management are common in Germany. However, strategies widely considered effective, such as the systematic cross-institutional surveillance of antimicrobial use and bacterial resistance in a standardized manner or the employment of infectious disease specialists, are scarce. This study provides a benchmark for future antibiotic stewardship programs.
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité Berlin, Hindenburgdamm 27, 12203, Berlin, Germany, friederike.maechler@charite.de.
authors.forename: F
authors.initials: F
authors.lastname: Maechler
authors.forename: F
authors.initials: F
authors.lastname: Schwab
authors.forename: C
authors.initials: C
authors.lastname: Geffers
authors.forename: E
authors.initials: E
authors.lastname: Meyer
authors.forename: R
authors.initials: R
authors.lastname: Leistner
authors.forename: P
authors.initials: P
authors.lastname: Gastmeier
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000592:standards*; D004363:Drug Utilization / Q000592:standards*; D005858:Germany; D006801:Humans; D007362:Intensive Care Units; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents