Antimicrobial stewardship at a tertiary center in Portugal - insights from prescribers

Sep 29, 2026

Uploaded by Elsa

Objective: evaluate physician engagement with an antimicrobial stewardship program (ASP) at a tertiary hospital and identify delivery gaps for stewardship interventions. Design: cross-sectional survey study. Setting: a 1200-bed tertiary public hospital in Portugal. Participants: inpatient prescribing-privileged physicians invited via institutional email. Methods covered six domains from antibiotic knowledge to participation in multidisciplinary case discussions. Results: 154 respondents (10%); protocol awareness was common, protocol consultation was low, case discussions were limited but considered highly useful; restrictive policies shaped prescribing and respondents requested regular feedback on use and resistance trends. Conclusions: improve protocol accessibility, expand case-based discussions, clarify restriction communication, and establish consistent feedback loops.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Objective

Design

Setting

Participants

Methods

Results

Conclusions

Introduction

AMR and national initiatives

Portugal’s PPCIRA and ASP requirements

Rationale and study context

Antimicrobial Stewardship & Healthcare Epidemiology (2026), 6, e8, 1–7 doi:10.1017/ash.2025.10263 Original Article Antimicrobial stewardship at a tertiary center in Portugal: insights from prescribers André Valois MD1,2 , Mariana Salvado de Morais MD3, Lúcia Ribeiro Dias MD4,5 , Francisco Almeida MD6,7, Mariana Guedes MD6 , Paulo Andrade MD5,6 and Nuno Rocha-Pereira MD4,6 1Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal, 2Clinical Pharmacology Unit, São João Local Health Unit (ULS São João), Porto, Portugal, 3Internal Medicine Department, São José Local Health Unit (ULS de São José), Lisbon, Portugal, 4Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal, 5Infectious Diseases Department, São João Local Health Unit (ULS São João), Porto, Portugal, 6Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, São João Local Health Unit (ULS São João), Porto, Portugal and 7Department of Public Health and Forensic Sciences and Medical Education, University of Porto, Porto, Portugal Abstract Objective: To evaluate physician engagement with an antimicrobial stewardship program (ASP) at a tertiary hospital and identify areas for improvement in the delivery of stewardship interventions. Design: Cross-sectional survey study. Setting: A 1200-bed tertiary care public hospital in Portugal. Participants: Physicians with antibiotic prescribing privileges in inpatient settings. All physicians with active institutional e-mail addresses were invited to participate. Methods: An anonymous web-based questionnaire was administered between June and December 2024 . The survey addressed six domains: (1) antibiotic knowledge; (2) awareness and use of local prescribing protocols; (3) access to antimicrobial use and resistance reports;(4) awareness of antibiotic restriction policies; (5) use of informal consultations with the stewardship team; and (6) participation in scheduled multidisciplinary case discussions. Results: A total of 154 prescribing physicians responded (response rate: 10%), including specialists (75.3%) and residents (24.0%) . Most respondents were aware of institutional protocols (78.6%), but 66.9% reported rarely or never consulting them, citing accessibility and reliance on personal knowledge as key barriers. Participation in case discussions was limited (25.3%) but viewed as highly useful. Awareness of restrictive antibiotic policies was low; however, 69.5% indicated that these policies influenced their prescribing behavior. Respondents expressed strong interest in regular feedback on antimicrobial use and resistance trends. Conclusions: Key areas for improvement in ASP implementation include enhancing access to protocols, expanding case-based discussions, clarifying communication around restrictions, and establishing regular feedback mechanisms. These findings may inform efforts to align ASP strategies with clinical realities in similar hospital settings. (Received 23 September 2025; accepted 5 December 2025) Introduction Antimicrobial resistance (AMR) is a major public health threat worldwide. Various national and international entities have launched initiatives to prevent its emergence and to promote the rational use of antibiotics.1,2 This concern was most recently reaffirmed in the 2024 United Nations High-Level Meeting on AMR,3 where Heads of State emphasized the need to strengthen Corresponding author: André Valois; Email: [avalois@med.up.pt](avalois@med.up.pt) Cite this article: Valois A, Salvado de Morais M, Ribeiro Dias L, et al. Antimicrobial stewardship at a tertiary center in Portugal: insights from prescribers. Antimicrob Steward Healthc Epidemiol 2026. doi: 10.1017/ash.2025.10263 multisectoral responses through antimicrobial stewardship (AMS) and other coordinated efforts. In Portugal, the National Program for the Prevention and Control of Infections and Antimicrobial Resist

FAQs

What was the main objective of this study on antimicrobial stewardship?

To evaluate physician engagement with an antimicrobial stewardship program at a tertiary hospital and identify areas for improvement in how stewardship interventions are delivered.

How was physician engagement assessed in this survey study?

Through an anonymous web-based questionnaire covering six domains, including antibiotic knowledge, use of local protocols, access to reports, awareness of restriction policies, informal consultations with the stewardship team, and participation in multidisciplinary case discussions.

What were the key findings regarding protocol use and case discussions?

Most respondents were aware of institutional protocols, but many reported rarely or never consulting them. Participation in case discussions was limited, though respondents viewed these discussions as highly useful.

Sep 29, 2026

Uploaded by Elsa