Antimicrobial stewardship: are we failing in cross-specialty clinical engagement?

Abstract

Background: Antimicrobial resistance (AMR) is a public health priority and leading patient safety issue. Globally, antimicrobial stewardship (AMS) has been integral in promoting therapeutic optimization whilst minimizing harmful antimicrobial use. A cross-sectional, observational study was undertaken to investigate the coverage of AMS and antibacterial resistance across clinical scientific conferences in 2014, as a surrogate marker for current awareness and attributed importance.

Methods: Clinical specialties were identified, and the largest corresponding clinical scientific/research conferences in 2014 determined (i) within the UK and (ii) internationally. Conference characteristics and abstracts were interrogated and analysed to determine those related to AMS and AMR. Inter-specialty variation was assessed using χ(2) or Fisher's exact statistical analysis.

Results: In total, 45 conferences from 23 specialties were analysed representing 59,682 accepted abstracts. The UK had a significantly greater proportion of AMS-AMR-related abstracts compared with international conferences [2.8% (n = 221/7843) compared with 1.8% (n = 942/51,839); P < 0.001]. Infection conferences contained the greatest proportion of AMS-AMR abstracts, representing 20% (732/3669) of all abstracts [UK 66% (80/121) and international 18% (652/3548); P < 0.0001]. AMS-AMR coverage across all general specialties was poor [intensive care 9% (116/1287), surgical 1% (8/757) and medical specialties 0.64% (332/51,497)] despite high usage of antimicrobials across all.

Conclusions: Despite current AMS-AMR strategies being advocated by infection specialists and discussed by national and international policy makers, AMS-AMR coverage remained limited across clinical specialty scientific conferences in 2014. We call for further intervention to ensure specialty engagement with AMS programmes and promote the AMR agenda across clinical practice.

Figure 1.

Accepted conference abstract search criteria and definitions.

Figure 2.

Selection method to identify AMS-AMR abstracts among state-of-the-art conferences in 2014.

Figure 3.

AMS- and/or AMR-related abstracts from UK and international state-of-the-art clinical scientific conferences in 2014. *UK significantly greater than international conferences (P < 0.05). #International significantly greater than UK conferences (P < 0.05). Risk score: H = high, M = medium and L = low (calculated from the ECDC pilot point-prevalence survey of HCAI and AU data). n/a, not available.