Hospital-based Antimicrobial Stewardship in Denmark, Greenland, and the Faroe Islands - Current landscape and barriers.

OBJECTIVES: To describe the current organization and implementation of formalized, multidisciplinary hospital-based antimicrobial stewardship (AMS) structures in Denmark, the Faroe Islands, and Greenland.

METHODS: 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.

RESULTS: Overall, 145 individual responses representing 20 hospitals were received. Nine hospitals (45%) reported a formal AMS-strategy, eight (40%) a formal organizational multidisciplinary structure and a multidisciplinary 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%).

CONCLUSIONS: Core elements important for multidisciplinary hospital-based AMS can be strengthened in Danish hospitals. Funding, clear mandates, prioritization from the hospital management, and the implementation of multidisciplinary AMS-structures may help close the identified gaps.