Broom J, Broom A, Kirby E, Gibson A F, Post J J
Sunshine Coast Hospital and Health Service and the University of Queensland, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia.
J Hosp Infect. 2017 Aug;96(4):316-322. doi: 10.1016/j.jhin.2017.05.001. Epub 2017 May 5.
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.
To explore the perceptions of hospital respiratory clinicians on AMS in respiratory medicine.
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.
Four key barriers to the integration of AMS processes within respiratory medicine, from the participants' perspectives, were identified: 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.
在医院医学和初级保健中，呼吸道感染抗生素使用不当的情况普遍存在。医院内的抗菌药物管理（AMS）团队通常由传染病医生领导，经常负责优化呼吸道抗生素的使用，但关于推动该临床医学领域抗生素使用的因素，或关于抗菌药物管理如何被看待的信息有限。
探讨医院呼吸科临床医生对抗菌药物管理在呼吸医学中应用的看法。
对澳大利亚两家医院的28名临床医生（13名医生和15名护士）进行了深入访谈。采用框架法对数据进行主题分析。
从参与者的角度来看，确定了抗菌药物管理流程在呼吸医学中整合的四个关键障碍：
抗菌药物管理流程是在具有既定社会结构和知识基础的医院中引入的。本研究发现，呼吸医学中的抗菌药物管理与许多这些动态因素存在挑战和冲突。如果不考虑这些动态因素的影响，抗菌药物管理流程可能无法有效控制医院呼吸医学中的抗生素使用。
