Hospital-based antimicrobial stewardship in Denmark, Greenland and the Faroe Islands – current landscape and barriers

• Published in: The Journal of hospital infection Vol. 146; pp. 66 - 75
• Main Authors: Kraef, C., Öbrink-Hansen, K., Hertz, M., Hagen, T.L., Deutch, S., Holler, J.G., Olesen, B.R., Holm, M., Gaini, S., Koch, A., Benfield, T., Rosenvinge, F.S., Johansen, I.S.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2024
• Subjects: Antimicrobial resistance; Antimicrobial stewardship; Denmark; Faroe Islands; Greenland; Hospital; Denmark; Antimicrobial stewardship; Antimicrobial resistance; Hospital; Greenland; Faroe Islands
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2024.01.018

To describe the current organization and implementation of formalized, multi-disciplinary hospital-based antimicrobial stewardship (AMS) structures in Denmark, the Faroe Islands and Greenland. A structured electronic questionnaire was sent to all trainees and specialists in clinical microbiology (N=207) and infectious diseases (N=260), as well as clinical pharmacists (N=20) and paediatricians (N=10) with expertise in infectious diseases. The survey had 30 multiple-choice, rating-scale, and open-ended questions based on an international consensus checklist for hospital AMS, adapted to a Danish context. Overall, 145 individual responses representing 20 hospitals were received. Nine hospitals (45%) reported a formal AMS strategy, eight (40%) a formal organizational multi-disciplinary structure and a multi-disciplinary AMS team, and six (30%) a designated professional as a leader of the AMS team. A majority of hospitals reported access to updated guidelines (80%) and regularly monitored and reported the quantity of antibiotics prescribed (70% and 65%, respectively). Only one hospital (5%) reported a dedicated, sustainable and sufficient AMS budget, three hospitals (15%) audited courses of therapy for specific agents/clinical conditions and four hospitals (20%) had a document clearly defining roles, procedures of collaboration and responsibilities for AMS. A total of 42% of all individual respondents had received formal AMS training. Main barriers were a lack of financial resources (52%), a lack of mandate from the hospital management (30%) and AMS not being a priority (18%). Core elements important for multi-disciplinary hospital-based AMS can be strengthened in Danish hospitals. Funding, clear mandates, prioritization from the hospital management and the implementation of multi-disciplinary AMS structures may help close the identified gaps.