Roberti Javier, Jorro-Barón Facundo, Ini Natalí, Guglielmino Marina, Rodríguez Ana Paula, Echave Cecilia, Falaschi Andrea, Rodríguez Viviana E, García-Elorrio Ezequiel, Alonso Juan Pedro
From the Epidemiology and Public Health Research Center (CIESP), CONICET, Buenos Aires, Argentina.
Quality, Patient Safety and Clinical Management, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
Pediatr Qual Saf. 2025 Jan 7;10(1):e788. doi: 10.1097/pq9.0000000000000788. eCollection 2025 Jan-Feb.
In the pediatric setting, overprescribing of antibiotics contributes to the rise of multidrug-resistant organisms. Antimicrobial stewardship programs (ASPs) are recommended to optimize antibiotic use and combat resistance. However, the implementation of ASPs in low- and middle-income countries faces several challenges. This study aimed to evaluate the implementation process of a multifaceted ASP in 2 pediatric hospitals in Argentina.
A qualitative study was conducted in two large public children's hospitals in Argentina, using semistructured interviews with 32 healthcare providers at the beginning and end of the ASP implementation. The study was guided by the normalization process theory.
The intervention faced challenges, including limited understanding of its objectives, confusion with existing practices, and insufficient commitment from senior staff. Although junior staff were more receptive, communication barriers with external staff and workload concerns hindered broader adoption. Infectious disease specialists primarily led implementation, with limited involvement of other staff, particularly in training activities. Despite these challenges, participants reported improvements, such as the development of standardized antibiotic guidelines, better interdisciplinary collaboration, and improved communication. However, organizational support and resistance to new practices remained barriers.
This study highlights the importance of organizational context and staff commitment in ASP implementation. Tailored strategies that address the specific challenges of low- and middle-income countries are needed to effectively implement ASPs.
在儿科环境中，抗生素的过度处方导致了多重耐药菌的增加。推荐实施抗菌药物管理计划（ASP）以优化抗生素使用并对抗耐药性。然而，在低收入和中等收入国家实施ASP面临若干挑战。本研究旨在评估阿根廷两家儿科医院中一个多方面ASP的实施过程。
在阿根廷的两家大型公立儿童医院开展了一项定性研究，在ASP实施开始和结束时对32名医疗服务提供者进行了半结构化访谈。该研究以规范化过程理论为指导。
该干预面临挑战，包括对其目标的理解有限、与现有做法的混淆以及高级 staff 的投入不足。尽管初级 staff 更易接受，但与外部 staff 的沟通障碍和工作量问题阻碍了更广泛的采用。传染病专家主要领导实施工作，其他 staff 的参与有限，尤其是在培训活动方面。尽管存在这些挑战，参与者报告了一些改进，如制定标准化抗生素指南、更好的跨学科协作以及改善沟通。然而，组织支持和对新做法的抵触仍然是障碍。
本研究强调了组织背景和 staff 投入在ASP实施中的重要性。需要制定针对低收入和中等收入国家具体挑战的量身定制策略，以有效实施ASP。
