Abstract Objective: Antimicrobial stewardship programs (ASPs) have been required in Canadian hospitals since 2013 to address antimicrobial resistance. We evaluated ASP structure, resourcing, and strategy implementation across Ontario. Methods: We conducted a cross-sectional survey of inpatient hospitals (January–March 2026) in Ontario assessing funding and implementation of selected stewardship strategies. Results were summarized descriptively and stratified by hospital type and compared to national recommendations on resourcing. Results: Of 128 eligible hospitals, 93 (73%) responded, of which 89/93 (96%) reported having a formal or planned ASP. Designated funding was reported by 63%, varying by hospital type (89% of teaching vs. 21% of small hospitals). Among larger hospitals, the average ASP staffing was 0.19 pharmacist and 0.04 physician full-time equivalents (FTE) per 100 beds, below national recommendations of 0.3 pharmacist and 0.1 physician FTEs per 100 beds. Thirty-six percent (32/89) reported inclusion of goals to improve antimicrobial stewardship practices or antimicrobial use into the strategic or quality improvement plan. While 75% tracked hospital-wide antimicrobial use, only 44% routinely shared data with prescribers. Common strategies included antibiograms (84%), IV-to-PO conversion (67%), prospective audit and feedback (PAF) (65%), and facility-specific guidelines (62%). Newer interventions included allergy assessment (46%) and clinical decision support (50%). PAF varied considerably in scope, frequency, and target populations, with lower uptake and greater variability in smaller hospitals. Conclusions: Ontario hospital ASPs are advancing in areas such as allergy assessment and clinical decision support; however, under-resourcing continues to be a significant challenge. Greater investment and system-level support are needed to meet evolving standards and optimize impact.
