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Int J Antimicrob Agents. 2018 Jun;51(6):829-835. doi: 10.1016/j.ijantimicag.2018.01.002. Epub 2018 Jan 12.

Experiences and perspectives of implementing antimicrobial stewardship in five French hospitals: a qualitative study.

Author information

1
IAME, UMR 1137, DeSCID Team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: anne.perozziello@aphp.fr.
2
Institut du Management/EA 7348 MOS Management des organisations en santé, Ecole des hautes études en santé publique, EHESP, Rennes Sorbonne Paris Cité, Paris, France.
3
NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infection, Imperial College London, Department of Medicine, London, UK.
4
IAME, UMR 1137, DeSCID Team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
5
Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
6
IAME, UMR 1137, DeSCID Team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France.
7
IAME, UMR 1137, DeSCID Team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Unité d'Hygiène et de Lutte contre les Infections Nosocomiales (UHLIN), Hôpital Bichat-Claude Bernard, AP-HP, Paris, France.
8
INSERM U1137, Paris.
9
Hôpital Henri Mondor, AP-HP, Créteil.
10
Hôpital Foch, Suresnes.
11
CCLIN Paris Nord, Paris.
12
Hôpital Bichat, AP-HP, Paris.
13
Hôpital Avicenne, AP-HP, Bobigny.

Abstract

The aim of this study was to describe current antimicrobial stewardship programmes (ASPs) in France, both at policy level and at local implementation level, and to assess how ASP leaders (ASPL) worked and prioritised their activities. A qualitative study based on face-to-face semi-structured interviews with healthcare professionals responsible for ASPs across five French hospitals was conducted. Five infectious diseases specialists and one microbiologist were interviewed between April-June 2016. Stewards had dedicated time to perform ASP activities in two university-affiliated hospitals, whilst in the other hospitals (one university, one general and one semi-private), ASPLs had to balance these activities with clinical practice. Consequently, they had to adapt interventions according to their resources (IT or human). Responding to colleagues' consultation requests formed baseline work. Systematic and pro-active measures allowed for provision of unsolicited counselling, whilst direct counselling on wards required appropriate staffing. ASPLs aimed at increasing clinicians' ability to prescribe adequately and awareness of the unintended consequences of inappropriate use of antibiotics. Thus, persuasive, e.g. education, measures were preferred to coercive ones. ASPLs faced several challenges in implementing the ASP: overcoming physicians' or units' reluctance; and balancing the influence of medical hierarchy and professional boundaries. Beyond resources constraints, ASPLs' conceptions of their work, as well as contextual and cultural aspects, led them to adopt a persuasive and collaborative approach of counselling. This is the first qualitative study regarding ASPs in France exploring stewards' experiences and points of view.

KEYWORDS:

Antibiotics; Antimicrobial resistance; Antimicrobial stewardship; Qualitative study

[Indexed for MEDLINE]

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