Table 4 Summary of typical challenges from the on-investigation

Organizational structure and hardware facilities

Multidisciplinary team (MDT) collaboration

Widespread issues in hospitals include infrequent MDT meetings, limited participation from the Infectious Diseases Department and clinical pharmacists, and minimal collaboration beyond case reviews.

Information systems

Some hospitals have underdeveloped information systems, insufficient for supporting prescription audits and reviews.

Hardware equipment

Issues in some hospitals include insufficient laboratory space and a lack of computers for medical record access.

Staffing and training

Staff numbers

A general shortage of staff, inconsistent task allocation and lack of professional knowledge in microbiology laboratory staff at some hospitals.

Staff training

Limited external training opportunities for microbiology laboratory staff and inadequate training in antimicrobial stewardship in some hospitals’ infectious disease departments.

Drug formulary and prescription management

Drug procurement

Most hospitals face issues with irrational antimicrobial supply catalogues and insufficient variety in antimicrobial procurement.

Prescription review

Some hospitals suffer from low-quality prescription reviews, particularly lacking in special-class antimicrobials.

Skin test management

Incomplete implementation of β-lactam skin testing guidelines in some hospitals.

Laboratory testing and quality control

Specimen submission

Common reluctance among clinical doctors to submit high-quality specimens such as blood and sterile body fluids.

Quality control

Issues include non-standard specimen types and insufficient proactive screening and enzymatic testing for resistant bacteria.

Clinical sampling and data reporting

Sampling standards

Rigid sampling standards in some hospitals do not accurately reflect clinical situations.

Reporting standards

Most hospitals have low reporting rates of fungal bloodstream infections and incomplete reporting data.