Objectives: With increasing global interest in hospital antimicrobial stewardship (AMS) programmes, there is a strong demand for core elements of AMS to be clearly defined on the basis of principles of effectiveness and affordability. To date, efforts to identify such core elements have been limited to Europe, Australia, and North America. The aim of this study was to develop a set of core elements and their related checklist items for AMS programmes that should be present in all hospitals worldwide, regardless of resource availability.


Methods: A literature review was performed by searching Medicine and relevant websites to retrieve a list of core elements and items that could have global relevance. These core elements and items were evaluated by an international group of AMS experts using a structured modified Delphi consensus procedure, using two-phased online in-depth questionnaires.

Results: The literature review identified seven core elements and their related 29 checklist items from 48 references. Fifteen experts from 13 countries in six continents participated in the consensus procedure. Ultimately, all seven core elements were retained, as well as 28 of the initial checklist items plus one that was newly suggested, all with ≥80% agreement; 20 elements and items were rephrased.

Conclusions: This consensus on core elements for hospital AMS programmes is relevant to both high- and low-to-middle-income countries and could facilitate the development of national AMS stewardship guidelines and adoption by healthcare settings worldwide.

Voor volledig artikel klik hier, gepubliceerd in Clinical Microbiology and Infection Volume 25, issue 1 January 2019, Pages 20-25

Auteurs: C. Pulcini (1,2), F. Binda (1,2,3), A.S. Lamkang (4)A.Trett (4), E. Charani (5), D.A. Goff (6), S. Harbarth (7), S.L. Hinrichsen (8), G. Levy-Hara (9), M. Mendelson (10), D. Nathwani (11), R. Gunturu (12), S. Singh (13), A. Srinivasan (14), V. Thamlikitkul (15), K. Thursky (16), E. Vlieghe (17, 18, 19), H. Wertheim (20),  M. Zeng (21),  S. Gandra (4), R. Laxminarayan (4,22)

1)Université de Lorraine, APEMAC, Nancy, France
2)Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
3)University of Milan, Department of Biomedical and Clinical Sciences «Luigi Sacco», Milan, Italy
4)Center for Disease Dynamics, Economics & Policy (CDDEP), New Delhi, India
5)Imperial College London, Department of Medicine, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, London, UK
6)The Ohio State University Wexner Medical Center, Columbus, OH, USA
7)Geneva University Hospitals, Infection Control Program and WHO Collaborating Center, Faculty of Medicine, Geneva, Switzerland
8)Universidade Federal de Pernambuco (UFPE), Tropical Diseases Department, Recife, Brazil
9)Hospital Carlos G Durand, Unit of Infectious Diseases, Buenos Aires, Argentina
10)Groote Schuur Hospital, University of Cape Town, Department of Medicine, Division of Infectious Diseases & HIV Medicine, Cape Town, South Africa
11)Ninewells Hospital and Medical School, Dundee, UK
12)The Aga Khan University Hospital, Dept. of Pathology, Division of Clinical Microbiology, Nairobi, Kenya
13)Amrita Institute of Medical Sciences, Kochi, Kerala, India
14)Centers for Disease Control and Prevention, Atlanta, GA, USA
15)Mahidol University, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
16)National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital at the Peter Doherty Institute, Melbourne, Australia
17)University Hospital Antwerp, Department of General Internal Medicine, Infectious Diseases & Tropical Medicine, Antwerp, Belgium
18)University of Antwerp, Global Health Institute, Antwerp, Belgium
19)Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium
20)Radboudumc, Department of Medical Microbiology and Radboud Center for Infectious Diseases, Nijmegen, The Netherlands
21)Children's Hospital of Fudan University, Department of Infectious Diseases, Shanghai, China
22)Princeton University, Princeton, NJ, USA

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