Paulo Andrade

Background/Objectives: Antimicrobial stewardship programs (ASPs) are essential to promote rational antibiotic use and limit resistance. However, their impact depends on how they are perceived and applied in clinical settings. This study aimed to identify areas for improvement in a hospital ASP and to offer a model for assessing prescriber engagement with stewardship activities. Methods: We conducted a cross-sectional survey between March and December 2024 among physicians prescribing antibiotics at a 1200-bed tertiary hospital in Portugal. The anonymized questionnaire covered six domains: (1) antibiotic knowledge; (2) awareness and use of local protocols; (3) access to antimicrobial use and resistance reports; (4) awareness of restrictive prescribing policies; (5) use of unscheduled consultations with the stewardship team; and (6) participation in scheduled multidisciplinary case discussions. Results: Of 1,539 invited physicians, 154 responded (10%). Most were female (64.3%) and specialists (75.8%). Although 78.6% were aware of institutional protocols, 66.9% rarely or never consulted them, citing poor accessibility and reliance on personal knowledge. Only 25.3% participated in regular case discussions, but these were widely viewed as useful. Awareness of restrictive policies was limited, although 69.5% acknowledged that such measures influenced prescribing. Respondents valued expert consultation, protocols, and feedback on antibiotic use. Interest in regular feedback on antimicrobial use and resistance patterns was high. Conclusions: Four main areas for improvement were identified: (1) improving access to protocols, (2) expanding weekly case-based discussions, (3) improving communication on restrictions, and (4) delivering clear, actionable feedback. This approach may serve as a model for aligning ASPs with clinical practice.

Introduction: Febrile neutropenia (FN) is a potentially severe entity, particularly in hemato-oncologic patients who have higher incidence of colonization with multidrug-resistant bacteria. Discrepancies among guidelines contribute to divergence in antimicrobial practices. Our objective was to assess the variation of practices in antimicrobial therapy in high-risk FN among Portuguese hematologists. Methods: We conducted a cross-sectional study through the implementation of an online survey, open to all clinical hematologists in the country. To characterize practice patterns regarding critical elements in FN management, three clinical vignettes were designed to describe typical situations where narrow-spectrum empiric antibiotics (vignette 1), short-course therapy (vignette 2) and de-escalation (vignette 3) could be performed. The remaining questions characterized clinical experience, department size, and differentiation and decision-making process regarding FN antibiotic therapy. Results: The survey yielded 31 responses from 11 hospitals across four regions. All respondents opted for empiric narrow-spectrum antibiotics, 22.6% opted for short-course therapy (mostly senior specialists from larger settings) and 35.5% for de-escalation (mostly young specialists). Availability of an FN protocol seemed to favor both approaches. These findings should be complemented by qualitative assessments of barriers to best practices and should support the need for interventions to improve antibiotic use in febrile neutropenia.