How do hospital respiratory clinicians perceive antimicrobial stewardship (AMS)? A qualitative study highlighting barriers to AMS in respiratory medicine

Background: Suboptimal antibiotic use in respiratory infections is widespread in hospital medicine and primary care. Antimicrobial stewardship (AMS) teams within hospitals, commonly led by infectious diseases physicians, are frequently charged with optimizing the use of respiratory antibiotics, but there is limited information on what drives antibiotic use in this area of clinical medicine, or on how AMS is perceived. Aim: To explore the perceptions of hospital respiratory clinicians on AMS in respiratory medicine. Methods: In-depth interviews were conducted with 28 clinicians (13 doctors and 15 nurses) from two hospitals in Australia. Data were analysed thematically using the framework approach. Findings: Four key barriers to the integration of AMS processes within respiratory medicine, from the participants' perspectives, were identified: 1. Clinical ownership of common respiratory infections by the respiratory team is perceived to be challenged by AMS processes. 2. AMS processes conflict with traditional hierarchies and consultation etiquette in respiratory medicine. 3. Barriers to respiratory nursing engagement in AMS include lack of knowledge/education and perceived restrictions to their role. 4. AMS processes result in significant interspecialty and interprofessional challenges that may undermine antibiotic optimization. Conclusions: AMS processes are introduced in hospitals with established social structures and knowledge bases. This study found that AMS in respiratory medicine challenges and conflicts with many of these dynamics. If the influence of these dynamics is not considered, AMS processes may not be effective in containing antibiotic use in hospital respiratory medicine. (C) 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.