Nationwide Survey of Antimicrobial Stewardship in Korean Hospitals: Insights From the Early Stage of the 2024 National Pilot Implementation.

BACKGROUND

Antimicrobial stewardship programmes (ASPs) are essential for optimising antibiotic use and mitigating antimicrobial resistance. In Korea, antimicrobial consumption exceeds the Organisation for Economic Co-operation and Development average, and ASP activities remain fragmented, particularly in smaller hospitals. In November 2024, the National Health Insurance Service introduced a pilot reimbursement scheme to support ASPs in hospitals with ≥ 300 beds. This study aimed to provide baseline data to evaluate its impact.

METHODS

A nationwide web-based survey was conducted between January and February 2025 among 297 hospitals with ≥ 300 beds. The questionnaire was designed to allow comparison with the 2020 national survey and to assess the ASP infrastructure, resources, and practices.

RESULTS

Of 153 responding hospitals, 71 participated in the pilot programme. Participating hospitals were typically large, university-affiliated, and metropolitan-based; non-participants were smaller, non-teaching, and regional. Participating hospitals employed more infectious disease specialists (2.96 vs. 0.63) and paediatric infectious disease specialists (0.66 vs. 0.12) and allocated more full-time equivalent staff to ASP activities. Participants had stronger institutional support, including financial (46.5% vs. 1.2%) and workforce (52.1% vs. 2.4%) support. Guidelines, interventions, monitoring, and information technology-based decision support systems were more common in participating hospitals, which were all registered with the Korea National Antimicrobial Use Analysis System. Non-participating hospitals frequently lacked guidelines (62%) and interventions (48%). Both groups reported workforce shortages and insufficient incentives as major barriers.

CONCLUSION

The Korean ASP pilot programme strengthened the stewardship infrastructure in participating hospitals, even early on. However, substantial disparities with non-participating hospitals persist, underscoring the need for tailored support for resource-limited institutions.