OBJECTIVES:

Antimicrobial stewardship programmes (AmSPs) are widely reported to support appropriate antibiotic use and help control antibiotic resistance. However, the value of AmSPs has not been fully studied and there is a lack of established AmSP value evaluation framework in China. This study aimed to develop a China-specific AmSP evaluation framework by referring to the existing U.S. guidelines and supplementing with the unique characteristics of Chinese AmSPs.

METHODS:

Experts from geographically representative Chinese hospitals were interviewed face-to-face between August-October 2016 using the questionnaire developed based on the U.S. Center for Disease Control and Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection guidelines. An evaluation model framework adapted to the Chinese healthcare system was developed based on the US guidelines and survey responses.

RESULTS:

The interviewed experts were infectious disease specialists (n=6) or hospital/pharmacy directors (n=3) from 9 tertiary/Grade A hospitals with active AmSPs (average implementing time=3 years) in Beijing, Shanghai, Guangzhou, and Chengdu. Most components from the U.S. guidelines were incorporated into the Chinese framework with 3 main categories: resource needs (personnel, equipment), related clinical outcomes (antimicrobial resistant rate, mortality), and health economic impact (length of stay, defined daily dose). Main differences from U.S. include: 1) limited/no pharmacist involvement in routine participation in intravenous-to-oral switch programs, antibiotic dose modifications/discontinuations; 2) inclusion of more economic outcome endpoints of AmSPs (e.g., ICU use, reduced intravenous days due to early switch, hospital onset infection rate, and restricted antimicrobial drugs use); and 3) taking a hospital business case perspective by adding a return-on-investment calculation.

CONCLUSIONS:

This study is the first step to develop a comprehensive AmSP evaluation framework for Chinese hospitals. It will help Chinese hospital decision-makers measure the costs and benefits associated with their specific AmSP and gain a better understanding of their value, thus creating an enhanced engagement in implementing AmSPs.