Excellence in Antibiotic Stewardship: A Mixed-Methods Study Comparing High-, Medium-, and Low-Performing Hospitals

Area of Science:

• Healthcare Management
• Infectious Diseases
• Clinical Pharmacy

Background:

• Antibiotic stewardship programs are common in hospitals, yet appropriate antibiotic use varies.
• Research often focuses on individual prescribers, neglecting contextual factors driving these variations.

Purpose of the Study:

• To explore contextual factors influencing antibiotic overuse in acute care hospitals.
• To identify organizational characteristics associated with effective antibiotic stewardship.

Main Methods:

• An explanatory, sequential mixed-methods study was conducted across 7 hospitals with differing antibiotic overuse levels.
• Data collection involved surveys, document analysis, and semi-structured interviews with various hospital stakeholders.
• A case-study approach, using a SWOT framework, integrated findings to explain variations in antibiotic overuse.

Main Results:

• Hospitals with lower antibiotic overuse reported higher job satisfaction and comfort among clinical pharmacists.
• Key distinguishing characteristics included accessible stewardship guidance, strong pharmacist-physician relationships, supportive infrastructure, and engaged infectious diseases physicians.
• Pharmacists at low-overuse hospitals felt more respected and valued by colleagues.

Conclusions:

• Organizational context is crucial for high-performing antibiotic stewardship.
• Improving antimicrobial stewardship necessitates addressing knowledge access, clinical team interactions, and supportive infrastructure.