The Complexities of Antimicrobial Resistance in Acute Care: An Exploration of Key Actors and Factors Associated with Acute Care Antimicrobial Stewardship

Background Antimicrobial resistance (AMR) is an evolving global healthcare emergency, of which a significant driver is the use and overuse of antimicrobials. Antimicrobial stewardship (AMS) is a multi-component, multidisciplinary approach to addressing AMR by ensuring optimal antimicrobial use and minimising patient adverse outcomes. The hospital environment is an important context within which antimicrobials are used, owing to higher levels of patient co-morbidity and acuity. Ensuring that hospital based AMS programmes are fit for purpose and suited to the local clinical and cultural context will help ensure positive patient outcomes. Owing to the paucity of such research carried out in Irish acute care settings, this research aimed to investigate the actors, and associated factors, associated with antimicrobial use in the largest public acute hospital in Ireland. In doing so, a further aim was to postulate behaviour change strategies targeting these actors to optimise the impact of the St James s Hospital (SJH) AMS programme. Methods Hospital clinicians (medical doctors, surgeons, nurses and pharmacists) and hospital inpatients were recruited as key stakeholders in acute care AMS. The hospital patient council were invited as research collaborators. Recognising the hospital environment as a complex adaptive system, a mixed methods data collection approach was used, incorporating evidence synthesis, clinical audit, quantitative surveys, qualitative focus groups and interviews.