Integrated assessment of antimicrobial stewardship in carbapenem resistant Klebsiella pneumoniae prevalent hospitals in China: a multidisciplinary surveillance network-based survey.

BACKGROUND

China has established an extensive multidisciplinary surveillance network encompassing antimicrobial utilisation, antimicrobial resistance, and nosocomial infections. We aimed to identify challenges and barriers in antimicrobial stewardship (AMS) development based on this national multidisciplinary surveillance network.

METHODS

This cross-sectional study was conducted in 15 hospitals across China from July 2021 to April 2023. Purposeful sampling was employed to select the hospitals based on the rising prevalence of carbapenem-resistant Klebsiella pneumoniae. The survey consisted of three parts: a testing questionnaire was used to assess the awareness of clinical physicians regarding AMS; a scoring table was developed through the Delphi method to assess the hospitals' multidisciplinary management covering antibacterial usage surveillance, resistance surveillance, fungal surveillance, infectious disease management, and infection prevention and control; an on-site investigation based on case review and field inspection. Pearson correlation tests were used to examine the relationship between resistance levels and scores for various items. Theme analysis was applied to highlight key areas of focus in hospital multidisciplinary AMS from the on-site investigation.

RESULTS

Findings revealed that physicians of respiratory, infectious disease, and critical care were the top 3 specialists in AMS awareness scores, with an average of 70 points, 65 points and 62.5 points, respectively (a full mark of 100 points). Performance in infectious disease management, antibacterial surveillance, and infection prevention and control showed a scoring rate over 70%, with relatively low scores in resistance surveillance (49.1%) and fungal surveillance (36.0%). No significant correlation was found between any single scoring item and the resistance levels of focused drug-resistance pathogens. Five key areas were identified for improving multidisciplinary AMS: organizational structure, staffing and training, drug formulary and prescription management, laboratory testing and quality control, and clinical sampling and data reporting.

CONCLUSIONS

The prevalence of focused drug-resistance pathogens could not attribute to any single factor. The following AMS activities should emphasise the establishment of sophisticated communication and collaboration mechanisms within multidisciplinary teams.

TRIAL REGISTRATION

Approval for this study was granted by the Ethics Committee of Peking University (reference number IRB00001052-22100).