Antimicrobial Stewardship Program Implementation in a Saudi Medical City: An Exploratory Case Study

Area of Science:

• Healthcare Management
• Infectious Diseases
• Clinical Pharmacy

Background:

• Antimicrobial stewardship programs (ASPs) are crucial for optimizing antimicrobial use and combating antimicrobial resistance.
• Implementation of ASPs in hospitals, particularly in developing nations like Saudi Arabia, faces significant challenges, including a lack of implementation knowledge.

Purpose of the Study:

• To explore the implementation process of an antimicrobial stewardship program in a Saudi hospital.
• To identify challenges encountered during ASP implementation and the strategies used to overcome them.
• To evaluate the outcomes of the implemented ASP.

Main Methods:

• A key stakeholder case study design was employed.
• In-depth semi-structured interviews were conducted with core ASP team members.
• Analysis of 35 relevant hospital documents pertaining to ASP implementation.

Main Results:

• ASP implementation followed a top-down approach with distinct preparatory and implementation phases.
• Strong top management support was identified as critical for successful implementation.
• The program led to reduced rates of multi-drug resistance and decreased prescription of broad-spectrum antimicrobials.

Conclusions:

• Antimicrobial stewardship program implementation in hospitals is often administrator-driven rather than clinician-driven.
• Substantial input from infectious diseases and clinical pharmacy is vital throughout the implementation process.
• Outsourcing expertise and resources can effectively address initial implementation hurdles for ASPs.