title: An international cross-sectional survey of antimicrobial stewardship programmes in hospitals.
abstract: OBJECTIVE
  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.
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK p.howard@leeds.ac.uk.
authors.forename: P
authors.initials: P
authors.lastname: Howard
authors.affiliation: CHU de Nancy, Service de Maladies Infectieuses, Nancy, France Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, Nancy, France.
authors.forename: C
authors.initials: C
authors.lastname: Pulcini
authors.affiliation: Infectious Diseases Unit, Hospital Carlos G Durand, Buenos Aires, Argentina.
authors.forename: G
authors.initials: G
authors.lastname: Levy Hara
authors.affiliation: Leeds Institute for Health Sciences, University of Leeds, Leeds LS2 9LJ, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: West
authors.affiliation: Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK.
authors.forename: I M
authors.initials: IM
authors.lastname: Gould
authors.affiliation: Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Harbarth
authors.affiliation: Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
authors.forename: D
authors.initials: D
authors.lastname: Nathwani
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000592:standards*; D004363:Drug Utilization / Q000592:standards*; D014943:Global Health; D006302:Health Services Research; D006761:Hospitals; D006801:Humans; D016134:Organizational Policy
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic management; antibiotic policy; antibiotic prescription