Implementation of hospital antimicrobial stewardship programmes in low- and middle-income countries: a qualitative study from a multi-professional perspective in the Global-PPS network. - National Genomics Data Center (CNCB-NGDC)

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Implementation of hospital antimicrobial stewardship programmes in low- and middle-income countries: a qualitative study from a multi-professional perspective in the Global-PPS network.

Ines Pauwels, Ann Versporten, Diane Ashiru-Oredope, Silvia Figueiredo Costa, Herberth Maldonado, Ana Paula Matos Porto, Shaheen Mehtar, Herman Goossens, Sibyl Anthierens, Erika Vlieghe

Author Information

Ines Pauwels: Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. ines.pauwels@uantwerpen.be.
Ann Versporten: Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Diane Ashiru-Oredope: Antimicrobial Resistance (AMR) and Healthcare-Associated Infection (HCAI) Division, United Kingdom Health Security Agency (UKHSA), London, UK.
Silvia Figueiredo Costa: Centres for Antimicrobial Optimisation Network (CAMO-Net) Brazil, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
Herberth Maldonado: Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
Ana Paula Matos Porto: Department of Infectious Diseases, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
Shaheen Mehtar: Infection Control Africa Network, Cape Town, South Africa.
Herman Goossens: Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Sibyl Anthierens: Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Erika Vlieghe: Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.

PMID: 40188146 DOI: 10.1186/s13756-025-01541-6

BACKGROUND: Hospitals in low- and middle-income countries (LMIC) face context-specific challenges in implementing antimicrobial stewardship (AMS) programmes. The Global Point Prevalence Survey (Global-PPS) project has established a network of hospitals across 90 countries, using point prevalence surveys to monitor antimicrobial use and guide AMS activities. However, little is known about AMS implementation in these hospitals. Using qualitative research, we aim to explore the implementation process in LMIC hospitals within the Global-PPS network and the factors influencing it, identify potential implementation strategies, and evaluate the role of Global-PPS in this process.
METHODS: A qualitative study was conducted using semi-structured online interviews with healthcare workers (HCWs) involved in AMS in LMIC hospitals within the Global-PPS network. Participants were selected using a combination of convenience and purposive sampling and included clinicians, microbiologists, pharmacists, and nurses. Interviews followed a topic guide based on the integrated checklist of determinants of practice (TICD Checklist). Transcripts were analysed using a combination of inductive and deductive thematic analyses.
FINDINGS: Twenty-two HCWs from 16 countries were interviewed. Hospitals were in different stages of the AMS implementation process at the time of the study, from pre-implementation to institutionalisation of AMS as part of the continuous quality improvement process. While the Global-PPS provided a valuable tool for education and implementation, contextual barriers often hindered the translation of findings into targeted interventions. Four themes influenced AMS implementation, "institutional support and resource allocation", "AMS team functioning, roles, and expertise", "adoption and integration of AMS recommendations", and "data-driven decision-making" as a cross-cutting theme. Key determinants included AMS team competencies, multidisciplinary teams, sustainable funding and leadership support, diagnostic capacity, and reliable data to inform interventions. We also identified various strategies employed by local AMS teams to enhance implementation.
CONCLUSIONS: This study examines AMS implementation in LMIC hospitals in the Global-PPS network and identifies key determinants. AMS teams address challenges through task shifting, local engagement and ownership. While empirical evidence on the effectiveness of these strategies is limited, these insights can guide future AMS interventions and studies within LMIC hospitals. Strengthening AMS requires bridging the gap between measurement and action and expanding research on behaviour change.

Antibiotics Antimicrobial resistance Antimicrobial stewardship Hospital Low- and middle-income countries Qualitative research

Murray CJ, Shunji Ikuta K, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399:629–55. https://doi.org/10.1016/S0140-6736(21)02724-0 . [DOI: 10.1016/S0140-6736(21)02724-0]

World Health Organization. Global Action Plan on Antimicrobial Resistance. 2015. https://www.who.int/publications/i/item/9789241509763 . Accessed 12 Apr 2024.

World Health Organization. Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries. A practical toolkit. 2019. https://www.who.int/publications/i/item/9789241515481 . Accessed 9 Jan 2020.

Pulcini C, Binda F, Lamkang AS, Trett A, Charani E, Goff DA, et al. Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach. Clin Microbiol Infect. 2019;25:20–5. https://doi.org/10.1016/j.cmi.2018.03.033 . [DOI: 10.1016/j.cmi.2018.03.033]

CDC. Core Elements of Hospital Antibiotic Stewardship Programs. 2019. https://www.cdc.gov/antibiotic-use/core-elements/hospital.html . Accessed 26 Aug 2024.

Cox JA, Vlieghe E, Mendelson M, Wertheim H, Ndegwa L, Villegas MV, et al. Antibiotic stewardship in low- and middle-income countries: the same but different? Clin Microbiol Infect. 2017;23:812–8. https://doi.org/10.1016/j.cmi.2017.07.010 . [DOI: 10.1016/j.cmi.2017.07.010]

Van Dijck C, Vlieghe E, Cox JA. Antibiotic stewardship interventions in hospitals in low-and middle- income countries: a systematic review. Bull World Health Organ. 2018;96:266–80. https://doi.org/10.2471/BLT.17.203448 . [DOI: 10.2471/BLT.17.203448]

Rolfe R, Kwobah C, Muro F, Ruwanpathirana A, Lyamuya F, Bodinayake C, et al. Barriers to implementing antimicrobial stewardship programs in three low- and middle-income country tertiary care settings: findings from a multi-site qualitative study. Antimicrob Resist Infect Control. 2021;10:60. https://doi.org/10.1186/S13756-021-00929-4 . [DOI: 10.1186/S13756-021-00929-4]

Fabre V, Secaira C, Cosgrove SE, Lessa FC, Patel TS, Alvarez AA, et al. Deep dive into gaps and barriers to implementation of antimicrobial stewardship programs in hospitals in Latin America. Clin Infect Dis. 2023;77:S53. https://doi.org/10.1093/CID/CIAD184 . [DOI: 10.1093/CID/CIAD184]

Lorencatto F, Charani E, Sevdalis N, Tarrant C, Davey P. Driving sustainable change in antimicrobial prescribing practice: how can social and behavioural sciences help? J Antimicrob Chemother. 2018;73:2613–24. https://doi.org/10.1093/jac/dky222 . [DOI: 10.1093/jac/dky222]

Versporten A, Zarb P, Caniaux I, Gros M-F, Drapier N, Miller M, et al. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Health. 2018;6:e619–29. https://doi.org/10.1016/S2214-109X(18)30186-4 . [DOI: 10.1016/S2214-109X(18)30186-4]

Global-PPS. Global Point Prevalence Survey. Impact and Value. 2023. https://www.global-pps.com/documents/ . Accessed 12 Jun 2024.

Pauwels I, Versporten A, Vermeulen H, Vlieghe E, Goossens H. Assessing the impact of the global point prevalence survey of antimicrobial consumption and resistance (Global-PPS) on hospital antimicrobial stewardship programmes: results of a worldwide survey. Antimicrob Resist Infect Control. 2021;10:138. https://doi.org/10.1186/s13756-021-01010-w . [DOI: 10.1186/s13756-021-01010-w]

World Bank Data Help Desk. World Bank Country and Lending Groups 2023. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups . Accessed 31 Jul 2024.

Flottorp SA, Oxman AD, Krause J, Musila NR, Wensing M, Godycki-Cwirko M, et al. A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implement Sci. 2013;8:35. https://doi.org/10.1186/1748-5908-8-35 . [DOI: 10.1186/1748-5908-8-35]

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. https://doi.org/10.1191/1478088706QP063OA . [DOI: 10.1191/1478088706QP063OA]

Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:1–8. https://doi.org/10.1186/1471-2288-13-117 . [DOI: 10.1186/1471-2288-13-117]

Lincoln Y, Guba E. Naturalistic inquiry. Newbury Park, CA: Sage; 1985. [DOI: 10.1016/0147-1767(85)90062-8]

Harun MGD, Sumon SA, Hasan I, Akther FM, Islam MS, Anwar MMU. Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review. Antimicrob Resist Infect Control. 2024;13:1–19. https://doi.org/10.1186/S13756-024-01369-6 . [DOI: 10.1186/S13756-024-01369-6]

Wu S, Tannous E, Haldane V, Ellen ME, Wei X. Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the consolidated framework for implementation research. Implement Sci. 2022;17:30. https://doi.org/10.1186/S13012-022-01209-4 . [DOI: 10.1186/S13012-022-01209-4]

Organização Nacional de Acreditação (ONA). Instituições Acreditadoras Credenciadas 2025. https://www.ona.org.br/acreditadoras/instituicoes-acreditadoras-credenciadas . Accessed 30 Jan 2025.

National Accreditation Board For Hospitals & Healthcare Providers (NABH). Home 2025. https://nabh.co/ . Accessed 30 Jan 2025.

The Joint Commission. Joint Commission Accreditation 2025. https://www.jointcommission.org/what-we-offer/accreditation/ . Accessed 30 Jan 2025.

Van Vliet EJ, Soethout J, Churruca K, Braithwaite J, Luxford K, Stewart J, et al. International approaches for implementing accreditation programmes in different healthcare facilities: a comparative case study in Australia, Botswana, Denmark, and Jordan. Int J Qual Health Care. 2023;35:1–12. https://doi.org/10.1093/INTQHC/MZAD026 . [DOI: 10.1093/INTQHC/MZAD026]

Sneddon J, Drummond F, Guise T, Gilchrist M, Jenkins DR. Accreditation of antimicrobial stewardship programmes: addressing a global need to tackle antimicrobial resistance. JAC Antimicrob Resist. 2023;6. https://doi.org/10.1093/JACAMR/DLAE007 .

Healthcare Standards Organization. CAN/HSO 5030:2020 - Antimicrobial Stewardship Program 2024. https://healthstandards.org/standard/antimicrobial-stewardship-program/ . Accessed 7 Aug 2024.

Infectious Diseases Society of America (IDSA). Antimicrobial Stewardship Centers of Excellence 2024. https://www.idsociety.org/clinical-practice/antimicrobial-stewardship . Accessed 7 Aug 2024.

Australian Commission on Safety and Quality in Health Care. Antimicrobial Stewardship Clinical Care Standard. 2020. https://www.safetyandquality.gov.au/publications-and-resources/resource-library/antimicrobial-stewardship-clinical-care-standard-2020 . Accessed 7 Aug 2024.

British Society for Antimicrobial Chemotherapy. GAMSAS 2024. https://ams-accredit.com/ . Accessed 7 Aug 2024.

Nampoothiri V, Sangita Sudhir A, Varsha Joseph M, Mohamed Z, Menon V, Charani E, et al. Mapping the implementation of a clinical Pharmacist-Driven antimicrobial stewardship programme at a tertiary care centre in South India. Antibiotics. 2021;10:220. https://doi.org/10.3390/antibiotics10020220 . [DOI: 10.3390/antibiotics10020220]

Brink AJ, Messina AP, Feldman C, Richards GA, Becker PJ, Goff DA, et al. Antimicrobial stewardship across 47 South African hospitals: an implementation study. Lancet Infect Dis. 2016;16:1017–25. https://doi.org/10.1016/S1473-3099(16)30012-3 . [DOI: 10.1016/S1473-3099(16)30012-3]

Thi Lan Huong V, Thi Dieu Ngan T, Phuong Thao H, Minh Quang L, Thi Thu Hanh T, Thi Hien N, et al. Assessing feasibility of Establishing antimicrobial stewardship programmes in two provincial-level hospitals in Vietnam: an implementation research study. BMJ Open. 2021;11:53343. https://doi.org/10.1136/bmjopen-2021-053343 . [DOI: 10.1136/bmjopen-2021-053343]

Nyoloka N, Richards C, Mpute W, Chadwala HM, Kumwenda HS, Mwangonde-Phiri V, et al. Pharmacist-Led antimicrobial stewardship programme in two tertiary hospitals in Malawi. Antibiotics. 2024;13:480. https://doi.org/10.3390/ANTIBIOTICS13060480 . [DOI: 10.3390/ANTIBIOTICS13060480]

Kerr F, Sefah IA, Essah DO, Cockburn A, Afriyie D, Mahungu J, et al. Practical Pharmacist-Led interventions to improve antimicrobial stewardship in Ghana, Tanzania, Uganda and Zambia. Pharmacy. 2021;9:124. https://doi.org/10.3390/PHARMACY9030124 . [DOI: 10.3390/PHARMACY9030124]

Bos M, Schouten J, De Bot C, Vermeulen H, Hulscher M. A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses’ activities in daily practice regarding antibiotic use. JAC Antimicrob Resist. 2023;5. https://doi.org/10.1093/JACAMR/DLAD123 .

Nampoothiri V, Mbamalu O, Mendelson M, Singh S, Charani E. Pharmacist roles in antimicrobial stewardship: a qualitative study from India, South Africa and the united Kingdom. JAC Antimicrob Resist. 2024;6. https://doi.org/10.1093/JACAMR/DLAE047 .

Chater AM, Family H, Abraao LM, Burnett E, Castro-Sanchez E, Du Toit B, et al. Influences on nurses’ engagement in antimicrobial stewardship behaviours: a multi-country survey using the theoretical domains framework. J Hosp Infect. 2022;129:171–80. https://doi.org/10.1016/J.JHIN.2022.07.010 . [DOI: 10.1016/J.JHIN.2022.07.010]

Goff DA, Bauer KA, Brink A, Kolman S, Mendelson M, Messina AP, et al. International train the trainer antibiotic stewardship program for pharmacists: implementation, sustainability, and outcomes. J Am Coll Clin Pharm. 2020;3:869–76. https://doi.org/10.1002/JAC5.1228 . [DOI: 10.1002/JAC5.1228]

Brink A, Van den Bergh D, Mendelson M, Richards GA. Passing the baton to pharmacists and nurses: new models of antibiotic stewardship for South Africa? South Afr Med J. 2016;106:947. https://doi.org/10.7196/SAMJ.2016.v106i10.11448 . [DOI: 10.7196/SAMJ.2016.v106i10.11448]

Shamas N, Stokle E, Ashiru-Oredope D, Wesangula E. Challenges of implementing antimicrobial stewardship tools in low to middle income countries (LMICs). Infect Prev Pract. 2023;5:100315. https://doi.org/10.1016/j.infpip.2023.100315 . [DOI: 10.1016/j.infpip.2023.100315]

Charani E, Smith I, Skodvin B, Perozziello A, Lucet J-C, Lescure F-X, et al. Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries—A qualitative study. PLoS ONE. 2019;14:e0209847. https://doi.org/10.1371/journal.pone.0209847 . [DOI: 10.1371/journal.pone.0209847]

Ondoa P, Kapoor G, Alimi Y, Shumba E, Osena G, Maina M, et al. Bacteriology testing and antimicrobial resistance detection capacity of National tiered laboratory networks in sub-Saharan Africa: an analysis from 14 countries. Lancet Microbe. 2024;6:100976. https://doi.org/10.1016/j.lanmic.2024.100976 . [DOI: 10.1016/j.lanmic.2024.100976]

Wertheim HFL, Huong VTL, Kuijper EJ. Clinical microbiology laboratories in low-resource settings, it is not only about equipment and reagents, but also good governance for sustainability. Clin Microbiol Infect. 2021;27:1389–90. https://doi.org/10.1016/j.cmi.2021.07.027 . [DOI: 10.1016/j.cmi.2021.07.027]

Hassan SK, Dahmash EZ, Madi T, Tarawneh O, Jomhawi T, Alkhob W, et al. Four years after the implementation of antimicrobial stewardship program in Jordan: evaluation of program’s core elements. Front Public Health. 2023;11. https://doi.org/10.3389/fpubh.2023.1078596 .

Baur D, Gladstone BP, Burkert F, Carrara E, Foschi F, Döbele S, et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis. 2017;17:990–1001. https://doi.org/10.1016/S1473-3099(17)30325-0 . [DOI: 10.1016/S1473-3099(17)30325-0]

World Health Organization. Improving infection prevention and control at the health facility. Interim practical manual supporting implementation of the WHO Guidelines on Core Components of Infection Prevention and Control Programmes. 2018. https://www.who.int/publications/i/item/WHO-HIS-SDS-2018.10 . Accessed 8 Aug 2024.

World Health Organization. WHO competency framework for health workers’ education and training on antimicrobial resistance. 2018. https://www.who.int/publications/i/item/who-competency-framework-for-health-workers%E2%80%99-education-and-training-on-antimicrobial-resistance . Accessed 9 Aug 2024.

Donisi V, Sibani M, Carrara E, Del Piccolo L, Rimondini M, Mazzaferri F, et al. Emotional, cognitive and social factors of antimicrobial prescribing: can antimicrobial stewardship intervention be effective without addressing psycho-social factors? J Antimicrob Chemother. 2019;74:2844–7. https://doi.org/10.1093/JAC/DKZ308 . [DOI: 10.1093/JAC/DKZ308]

Chadborn T, Williams S, Jorgensen T, Price C, Buckel A, Altieri E. An approach for embedding behavioural science in antimicrobial resistance one health research. J Infect Public Health. 2023;16:134–40. https://doi.org/10.1016/J.JIPH.2023.11.001 . [DOI: 10.1016/J.JIPH.2023.11.001]

Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37. https://doi.org/10.1186/1748-5908-7-37 . [DOI: 10.1186/1748-5908-7-37]

Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42. https://doi.org/10.1186/1748-5908-6-42 . [DOI: 10.1186/1748-5908-6-42]

World Health Organization Regional Office for Europe. The TAP quick guide. A practical handbook for implementing Tailoring Antimicrobial Resistance Programmes. 2021. https://www.who.int/europe/publications/i/item/9789289055673 . Accessed 9 Aug 2024.

Lohiniva AL, Heweidy I, Girgis S, Abouelata O, Ackley C, Samir S, et al. Developing a theory-based behavior change intervention to improve the prescription of surgical prophylaxis. Int J Clin Pharm. 2022;44:227. https://doi.org/10.1007/S11096-021-01338-8 . [DOI: 10.1007/S11096-021-01338-8]

Radboudumc. Drive-AMS in Low- and Middle Income Countries. 2024. https://www.radboudumc.nl/en/education/courses/dutch-antimicrobial-stewardship/special-programs/drive-ams-in-lmics . Accessed 9 Aug 2024.

Cuevas C, Batura N, Wulandari LPL, Khan M, Wiseman V. Improving antibiotic use through behaviour change: a systematic review of interventions evaluated in low- and middle-income countries. Health Policy Plan. 2021;36:754–73. https://doi.org/10.1093/HEAPOL/CZAB021 . [DOI: 10.1093/HEAPOL/CZAB021]

Hsia Y, Lee BR, Versporten A, Yang Y, Bielicki J, Jackson C, et al. Use of the WHO access, watch, and reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries. Lancet Global Health. 2019;7:e861–71. https://doi.org/10.1016/S2214-109X(19)30071-3 . [DOI: 10.1016/S2214-109X(19)30071-3]

Pauwels I, Versporten A, Drapier N, Vlieghe E, Goossens H, Koraqi A, et al. Hospital antibiotic prescribing patterns in adult patients according to the WHO access, watch and reserve classification (AWaRe): results from a worldwide point prevalence survey in 69 countries. J Antimicrob Chemother. 2021;76:1614–24. https://doi.org/10.1093/jac/dkab050 . [DOI: 10.1093/jac/dkab050]

Porto APM, Goossens H, Versporten A, Costa SF. Global point prevalence survey of antimicrobial consumption in Brazilian hospitals. J Hosp Infect. 2020;104:165–71. https://doi.org/10.1016/J.JHIN.2019.10.016 . [DOI: 10.1016/J.JHIN.2019.10.016]

D’Arcy N, Ashiru-Oredope D, Olaoye O, Afriyie D, Akello Z, Ankrah D, et al. Antibiotic prescribing patterns in Ghana, Uganda, Zambia and Tanzania hospitals: results from the global point prevalence survey (G-PPS) on antimicrobial use and stewardship interventions implemented. Antibiotics. 2021;10:1122. https://doi.org/10.3390/ANTIBIOTICS10091122/S1 . [DOI: 10.3390/ANTIBIOTICS10091122/S1]

Singh SK, Sengupta S, Antony R, Bhattacharya S, Mukhopadhyay C, Ramasubramanian V, et al. Variations in antibiotic use across India: multi-centre study through global point prevalence survey. J Hosp Infect. 2019;103:280–3. https://doi.org/10.1016/J.JHIN.2019.05.014 . [DOI: 10.1016/J.JHIN.2019.05.014]

Saleem Z, Godman B, Cook A, Khan MA, Campbell SM, Seaton RA, et al. Ongoing efforts to improve antimicrobial utilization in hospitals among African countries and implications for the future. Antibiotics. 2022;11:1824. https://doi.org/10.3390/antibiotics11121824 . [DOI: 10.3390/antibiotics11121824]

Godman B, Egwuenu A, Haque M, Malande OO, Schellack N, Kumar S, et al. Strategies to improve antimicrobial utilization with a special focus on developing countries. Life. 2021;11:528. https://doi.org/10.3390/life11060528 . [DOI: 10.3390/life11060528]

Tattevin P, Levy Hara G, Toumi A, Enani M, Coombs G, Voss A, et al. Advocacy for increased international efforts for antimicrobial stewardship actions in Low-and Middle-Income countries on behalf of alliance for the prudent use of antimicrobials (APUA), under the auspices of the international society of antimicrobial chemotherapy (ISAC). Front Med. 2020;7:527243. https://doi.org/10.3389/fmed.2020.00503 . [DOI: 10.3389/fmed.2020.00503]

About drive-AMS. 2024. https://www.global-pps.com/about-ams/ . Accessed 20 Aug 2024.

Dirjayanto VJ, Lazarus G, Geraldine P, Dyson NG, Triastari SK, Anjani JV, et al. Efficacy of telemedicine-based antimicrobial stewardship program to combat antimicrobial resistance: A systematic review and meta-analysis. J Telemed Telecare. 2023. https://doi.org/10.1177/1357633X231204919 . [DOI: 10.1177/1357633X231204919]

Zacchaeus NGP, Palanikumar P, Alexander H, Webster J, Nair IK, Sadanshiv M, et al. Establishing an effective antimicrobial stewardship program at four secondary-care hospitals in India using a hub-and-spoke model. Antimicrob Stewardship Healthc Epidemiol. 2023;3. https://doi.org/10.1017/ASH.2023.171 .

Cohn J, Mendelson M, Kanj SS, Shafiq N, Boszczowski I, Laxminarayan R. Accelerating antibiotic access and stewardship: a new model to safeguard public health. Lancet Infect Dis. 2024;24:e584–90. https://doi.org/10.1016/S1473-3099(24)00070-7 . [DOI: 10.1016/S1473-3099(24)00070-7]

Antimicrobial Stewardship

Humans

Developing Countries

Qualitative Research

Hospitals

Health Personnel

Journal Article