Table 1

Participating hospital and intensive care unit characteristics

	Hospital 1	Hospital 2	Hospital 3	Hospital 4
Hospital type	Tertiary referral hospital	Specialist paediatric hospital	Private hospital	Academic secondary care hospital; also teaching and tertiary
Location	London, UK	London, UK	London, UK	Norfolk, UK
Hospital bed number	720	425	118	1200
ICU bed number	35	27	7	20
Hospital admissions (patients per year)	~160 000	43 218	9926	85 728
ICU admissions (patients per year)	3000	Paediatric ICU: 900 Neonatal ICU: 450	264	2174
ICU patient characteristics	A surgical/medical adult unit. Approximately half of the cases are admitted following major elective surgery; the other half comprise emergency medical and surgical patients. The unit specialises in the care of patients undergoing oncological treatments and patients undergoing extensive gastrointestinal, gynaecological and maxillofacial surgery. The active emergency department results in several unselected admissions from the local community.	Paediatric ICU: children and young people needing critical care for medical or surgical conditions (eg, oncology, neurology, renal, respiratory). Neonatal ICU: critically ill premature infants and babies up to 6 months old with complex medical and surgical problems (eg, necrotising enterocolitis, tracheo-oesophageal fistulae).	All adult ages; elective surgical cases, all specialties: medical (cardiac, respiratory, oncology); long-term intensive critical care; slow respiratory wean/rehabilitation patients.	Elective and emergency surgical cases.
Prescribing system	Electronic.	Electronic.	Paper.	Electronic.
ICU antibiotic prescribers	Consultants with clinical microbiology advice; pharmacist prescribers; early-career and middle-grade trainees can prescribe out-of-hours.	Paediatric ICU consultants and middle-grade staff prescribe. Advice is given by infectious disease and microbiology consultants, and pharmacists.	Consultants with clinical microbiology advice; middle-grade trainees can prescribe out-of-hours.	Consultants with clinical microbiology advice; early-career and middle-grade trainees can prescribe out-of-hours. No pharmacist prescribers at present.
Hospital antimicrobial stewardship programmes	Freely available, electronic antimicrobial guidelines (including sepsis guidelines) as well as a dedicated multidisciplinary team of pharmacists and microbiologists monitoring antimicrobial prescription with bedside consults as necessary.	Antibiotic stewardship programmes guide all antibiotic prescriptions, including the intensive care units. Regularly audit and report Trust and national governance data.	Freely available, electronic antimicrobial guidelines (including sepsis guidelines) as well as a dedicated multidisciplinary team of pharmacists and microbiologists monitoring antimicrobial prescription with bedside consults as necessary.	All antibiotics required to have an indication and review date (at latest 48 hours after initial prescription). Trust guidelines (including sepsis guidelines).
ICU antimicrobial stewardship programmes	A 6-day-per-week consultant clinical microbiologist who reviews every patient with an ICU doctor. A 24/7 on-call clinical microbiologist to discuss antibiotic choices, a prescribing algorithm, an antimicrobial pharmacist, an embedded infection control nurse and an antimicrobial formulary.	Consultant clinical microbiologists, infectious diseases doctors and virologists who review every patient with an ICU doctor at least twice a week. Antimicrobial stewardship pharmacists attend the majority of ward rounds.	Consultant clinical microbiologist, clinical pharmacist and infection control lead nurse do weekly stewardship rounds. A 24/7 on-call microbiologist to discuss antibiotic choices.	A 5-day-per-week consultant clinical microbiologist who reviews every patient with an ICU doctor. A 24/7 on-call microbiologist to discuss antibiotic choices. Trust guidelines and microbiology advice.

ICU, intensive care unit.