Monitoring of antimicrobial stewardship implementation in Swiss hospitals: results from a national survey

AIM: Antimicrobial stewardship (AMS) is essential to containing antimicrobial resistance. Under the Swiss Strategy on Antibiotic Resistance (StAR), a nationwide survey was conducted to assess antimicrobial stewardship implementation in acute care hospitals and inform future national stewardship strategies.

A total of 136 acute care hospitals in Switzerland were invited to complete a questionnaire adapted from a validated Dutch tool and modified for the Swiss context. The questionnaire gathered information on whether a formal antimicrobial stewardship programme was present (primary outcome), institutional characteristics, as well as key antimicrobial stewardship activities (secondary outcomes) such as guideline implementation, education, raising awareness, prescription restrictions, and audits. Descriptive statistics and analyses compared the implementation of antimicrobial stewardship activities by the presence of a formal antimicrobial stewardship programme.

Sixty-nine hospitals completed the survey (response rate: 51%); these hospitals represent 67% of all patient discharges in Switzerland in 2023. Although 86% reported engaging in at least one antimicrobial stewardship activity, only 47% had a formal antimicrobial stewardship programme (primary outcome). Most institutions reported providing infectious diseases specialist consult services (93%), clinical pharmacy support (84%), and microbiology advice (78%). Treatment guidelines (90%) and monitoring antimicrobial use (85%) were widely implemented. However, critical stewardship measures such as prescription audits with feedback were underutilised (20%), and few hospitals (18%) had allocated dedicated staff resources for antimicrobial stewardship. Hospitals with formal antimicrobial stewardship programmes reported key activities such as guideline use, prescriber education, antimicrobial restrictions, and audits more frequently.

This nationwide survey demonstrates encouraging progress in antimicrobial stewardship implementation since 2017, with most hospitals reporting stewardship activities and half having established a formal antimicrobial stewardship programme. However, critical gaps remain, highlighting the need for strengthened coordination and national support for hospitals to establish formal antimicrobial stewardship programmes to ensure the implementation and a sustainable impact of key antimicrobial stewardship activities.