Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach

Céline Pulcini (Lead / Corresponding author), Francesca Binda, Anjana Sankhil Lamkang, Anna Trett, Esmita Charani, Debra A. Goff, Stephan Harbarth, Sylvia Lemos Hinrichsen, Gabriel Levy-Hara, Marc Mendelson, Dilip Nathwani, Revathi Gunturu, Sanjeev Singh, Arjun Srinivasan, Visanu Thamlikitkul, Karin Thursky, Erika Vlieghe, Heiman Wertheim, Mei Zeng, Sumanth GandraRamanan Laxminarayan

    Research output: Contribution to journalArticlepeer-review

    117 Citations (Scopus)
    340 Downloads (Pure)


    Objectives: With increasing global interest in hospital antimicrobial stewardship (AMS) programmes, there is a strong demand for core elements of AMS to be clearly defined on the basis of principles of effectiveness and affordability. To date, efforts to identify such core elements have been limited to Europe, Australia, and North America. The aim of this study was to develop a set of core elements and their related checklist items for AMS programmes that should be present in all hospitals worldwide, regardless of resource availability.

    Methods: A literature review was performed by searching Medline and relevant websites to retrieve a list of core elements and items that could have global relevance. These core elements and items were evaluated by an international group of AMS experts using a structured modified Delphi consensus procedure, using two-phased online in-depth questionnaires.

    Results: The literature review identified seven core elements and their related 29 checklist items from 48 references. Fifteen experts from 13 countries in six continents participated in the consensus procedure. Ultimately, all seven core elements were retained, as well as 28 of the initial checklist items plus one that was newly suggested, all with ≥80% agreement; 20 elements and items were rephrased.

    Conclusions: This consensus on core elements for hospital AMS programmes is relevant to both high- and low-to-middle-income countries and could facilitate the development of national AMS stewardship guidelines and adoption by healthcare settings worldwide.

    Original languageEnglish
    Pages (from-to)20-25
    Number of pages6
    JournalClinical Microbiology and Infection
    Issue number1
    Early online date3 Apr 2018
    Publication statusPublished - Jan 2019


    • Antimicrobial resistance
    • Antimicrobial stewardship
    • Hospital
    • Low-income country
    • Middle-income country

    ASJC Scopus subject areas

    • Microbiology (medical)
    • Infectious Diseases


    Dive into the research topics of 'Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach'. Together they form a unique fingerprint.

    Cite this