Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study

Abstract

ObjectivesTo determine what barriers and facilitators to antibiotic stewardship exist within a healthcare facility.Setting1300-bed tertiary care private hospital located in the state of Kerala, India.Participants31 semistructured interviews and 4 focus groups with hospital staff ranging from physicians, nurses, pharmacists and a clinical microbiologist.ResultsKey facilitators of antibiotic stewardship (AS) at the hospital included a dedicated committee overseeing appropriate inpatient antibiotic use, a prompt microbiology laboratory, a high level of AS understanding among staff, established guidelines for empiric prescribing and an easily accessible antibiogram. We identified the following barriers: limited access to clinical pharmacists, physician immunity to change regarding stewardship policies, infrequent antibiotic de-escalation, high physician workload, an incomplete electronic medical record (EMR), inadequate AS programme (ASP) physical visibility and high antibiotic use in the community.ConclusionsOpportunities for improvement at this institution include increasing accessibility to clinical pharmacists, implementing strategies to overcome physician immunity to change and establishing a more accessible and complete EMR. Our findings are likely to be of use to institutions developing ASPs in lower resource settings.

Status of Antimicrobial Stewardship Implementation in Some Egyptian Hospitals, a Cross-sectional Study

“…Electronic Medical Record (EMR), Computerized Physician Order Entry (CPOE), Computer-assisted monitoring of antimicrobial prescriptions & hospital surveillance are among the IT activities performed. In agreement with our study, Baubie et al found that electronic medical record is an effective tool in an ASP [22].…”

“…In our study, antibiogram was not performed in 51.4% hospitals, 17.1% reported updated antibiogram every year and 31.4% of the hospitals issued antibiogram on a 6 months interval basis. Baubie et al also reported updating hospital antibiogram annually by hospital microbiologist & clinical pharmacists [22].…”

Antibiotic prescribing patterns and knowledge of antibiotic resistance amongst the doctors working at public health facilities of a state in northern India: A cross sectional study

“…Baubie et al . [ 21 ] identified that the presence of a microbiology laboratory, antibiogram, established guidelines for empiric prescribing, and committed leadership was important facilitators of an effective antibiotic stewardship program in a hospital. In Haryana, all 22 DHs have functional laboratories; however, well-equipped microbiology labs are functional in 12, and antibiograms are being generated in only 5.…”

Qualitative study of antibiotic prescription patterns and associated drivers in Sudan, Guinea-Bissau, Central African Republic and Democratic Republic of Congo

“…[6][7][8][9] Previous studies from low-and-middle-income countries (LMICs) have reported that patient demands often play a salient role in inconsistent prescription practices. [10][11][12][13][14][15] For example, Liu et al noted that rational prescribing practices are prone to weak control over prescribing behaviours, and 40% of prescriptions in a primary care setting in Hubei, China, contained an antibiotic, with 10% containing two or more antibiotics. 14 Where antibiotic stewardship efforts have worked, they have relied on dedicated committees overseeing antibiotic use, prompt laboratory investigations, established guidelines for empiric prescribing and an easily accessible antibiogram.…”