Evaluating the integrated antimicrobial stewardship system of China by the assessment tool of WHO.

Objective: To fully understand the overall system and implementation of antimicrobial stewardship (AMS) at different levels in China, an evaluation according to the integrated AMS evaluation tool developed by World Health Organization (WHO) was conducted. Methods: A comprehensive search on the AMS relevant government policies, regulations, scientific research results, public and social activities was conducted, and the implementation of AMS strategies in national, subnational and hospital level were evaluated by the standards of the WHO. Results: The results shew that the system construction, technical infrastructure and actions of AMS in China at the national level is relatively satisfied, but the AMS system needs to be further strengthened at the subnational and the medical institutional level, especially the integration of multidisciplinary teams and relevant departments; the implementation of professional intervention strategies, national education and publicity, professional education and training are relatively weak. AMS implementation is mainly promoted at the national level, and AMS in primary medical institutions is almost missing. It is necessary to carry out AMS at the provincial level and medical institutions as soon as possible. The focus is to establish a professional AMS team, prepare AMS guideline, implement AMS strategy, raise public awareness and ensure the long-term and sustainable development of AMS in the country. Conclusion: The Chinese government has established a system for AMS, and implemented a multisectoral coordinative mechanism. However, at the subnational and district levels, an AMS system and practice should be set up soon to promote the rational use of antibiotics.