Variation in approaches to antimicrobial use surveillance in high-income secondary care settings: A systematic review

Selina Patel*, Arnoupe Jhass, Ann Slee, Susan Hopkins, Laura Shallcross

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Introduction: In secondary care, antimicrobial use (AMU) must be monitored to reduce the risk of antimicrobial resistance and infection-related complications. However, there is variation in how hospitals address this challenge, partly driven by each site's level of digital maturity, expertise and resources available. This systematic review investigated approaches to measuring AMU to explore how these structural differences may present barriers to engagement with AMU surveillance. 

Methods: We searched four digital databases and the websites of relevant organizations for studies in high-income, inpatient hospital settings that estimated AMU in adults. Excluded studies focused exclusively on antiviral or antifungal therapies. Data were extracted data on 12 fields (study description, data sources, data extraction methods and professionals involved in surveillance). Proportions were estimated with 95% CIs. 

Results: We identified 145 reports of antimicrobial surveillance from Europe (63), North America (53), Oceania (14), Asia (13) and across more than continent (2) between 1977 and 2018. Of 145 studies, 47 carried out surveillance based on digital data sources. In regions with access to electronic patient records, 26/47 studies employed manual methods to extract the data. The majority of identified professionals involved in these studies were clinically trained (87/93). 

Conclusions: Even in regions with access to electronic datasets, hospitals rely on manual data extraction for this work. Data extraction is undertaken by healthcare professionals, who may have conflicting priorities. Reducing barriers to engagement in AMU surveillance requires investment in methods, resources and training so that hospitals can extract and analyse data already contained within electronic patient records.

Original languageEnglish
Pages (from-to)1969-1977
Number of pages9
JournalJournal of Antimicrobial Chemotherapy
Issue number8
Early online date24 Apr 2021
Publication statusPublished - Jul 2021

Bibliographical note

Funding Information: S.P. receives funding for this work from the Economic and Social Research Council (ESRC; grant number ES/P000592/1). A.J. receives funding from the National Institute of Health Research (NIHR; grant number NIHR300293).
S.H. was supported by funding from the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England (NIHR200915). L.S. was funded by a National Institute for Health Research (NIHR) Clinician Scientist award (CS2016-007) for this research project.

Open Access: This is an Open Access article distributed under the terms of the Creative Commons Attribution License (
by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Publisher Copyright: © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.

Citation: Patel S, Jhass A, Slee A, Hopkins S, Shallcross L. Variation in approaches to antimicrobial use surveillance in high-income secondary care settings: a systematic review. J Antimicrob Chemother. 2021 Jul 15;76(8):1969-1977.

DOI: 10.1093/jac/dkab125.


Dive into the research topics of 'Variation in approaches to antimicrobial use surveillance in high-income secondary care settings: A systematic review'. Together they form a unique fingerprint.

Cite this