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Antibiotic stewardship in Germany: a cross-sectional questionnaire survey of 355 intensive care units

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Little information is available on antibiotic prescription management in German hospitals. The objective of this cross-sectional study was to determine the prevalence and components of antibiotic stewardship measures in German intensive care units (ICUs).


A questionnaire survey was sent to all ICUs participating in the German nosocomial infection surveillance system (n = 579) in October 2011. Data on antibiotic management structures were collected and analyzed by structural hospital and ICU factors.


The questionnaire was completed by 355 German ICUs (response rate 61 %). Common measures used (>80 % of the ICUs) were personnel restrictions for antibiotic prescriptions, routine access to bacterial resistance data, and pharmacy reports on antibiotic costs and consumption. A small proportion of ICUs (14 %) employed physicians specialized in the prescription of antimicrobial medication. Hospitals with their own microbiological laboratory report participation in surveillance networks for antimicrobial use (34 %) and bacterial resistance (32 %) twice as often as hospitals with external laboratories (15 and 14 %, respectively, p < 0.001). Also, non-profit and public hospitals participate more often in surveillance networks for bacterial resistance than private hospitals (>23 % vs. 11 %, p < 0.05).


While the majority of ICUs report to have some antibiotic policies established, the contents and composition of these policies vary. Organizational-level control strategies to improve antibiotic management are common in Germany. However, strategies widely considered effective, such as the systematic cross-institutional surveillance of antimicrobial use and bacterial resistance in a standardized manner or the employment of infectious disease specialists, are scarce. This study provides a benchmark for future antibiotic stewardship programs.

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We thank all physicians and nurses in the participating hospitals who provided their antibiotic management data to KISS and Alexander Gropmann for programming the questionnaire survey. This work was supported by the German Ministry of Health (grant number IIA5-2511FSB106/321-4532-04/21). Data have been generated as part of the routine work of the nosocomial infection surveillance system (NRZ KISS).

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The authors declare that they have no conflicts of interest.

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Correspondence to F. Maechler.

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Maechler, F., Schwab, F., Geffers, C. et al. Antibiotic stewardship in Germany: a cross-sectional questionnaire survey of 355 intensive care units. Infection 42, 119–125 (2014).

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