What does antimicrobial stewardship look like where you are? Global narratives from participants in a massive open online course

Vrinda Nampoothiri; Candice Bonaconsa; Surya Surendran; Oluchi Mbamalu; Winnie Nambatya; Peter Ahabwe Babigumira; Raheelah Ahmad; Enrique Castro-Sanchez; Alex Broom; Julia Szymczak; Walter Zingg; Mark Gilchrist; Alison Holmes; Marc Mendelson; Sanjeev Singh; Monsey McLeod; Esmita Charani

doi:10.1093/jacamr/dlab186

What does antimicrobial stewardship look like where you are? Global narratives from participants in a massive open online course

JAC Antimicrob Resist. 2021 Dec 28;4(1):dlab186. doi: 10.1093/jacamr/dlab186. eCollection 2022 Mar.

Authors

Vrinda Nampoothiri¹, Candice Bonaconsa², Surya Surendran¹, Oluchi Mbamalu², Winnie Nambatya³, Peter Ahabwe Babigumira⁴, Raheelah Ahmad⁵, Enrique Castro-Sanchez⁵, Alex Broom⁶, Julia Szymczak⁷, Walter Zingg⁸, Mark Gilchrist⁹, Alison Holmes¹⁰, Marc Mendelson², Sanjeev Singh¹, Monsey McLeod¹⁰, Esmita Charani²

Affiliations

¹ Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India.
² Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
³ Department of Pharmacy, Makerere University, Kampala, Uganda.
⁴ Infectious Diseases Institute, Makerere University, Kampala, Uganda.
⁵ Division of Health Services Research and Management, School of Health Sciences, University of London, London, UK.
⁶ Department of Sociology and Social Policy, School of Social and Political Sciences, The University of Sydney, Sydney, Australia.
⁷ Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁸ Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
⁹ Department of Pharmacy, Imperial College Healthcare NHS Trust, London, UK.
¹⁰ Health Protection Research Unit in Healthcare Associated infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, London, UK.

Abstract

Background: Whilst antimicrobial stewardship (AMS) is being implemented globally, contextual differences exist. We describe how the use of a massive open online course (MOOC) platform provided an opportunity to gather diverse narratives on AMS from around the world.

Methods: A free 3 week MOOC titled 'Tackling antimicrobial resistance: a social science approach' was launched in November 2019. Learners were asked specific questions about their experiences of AMS via 38 optional free-text prompts dispersed throughout the modules. Content analysis was used to identify key emerging themes from the learners' responses in the first three runs of the MOOC.

Results: Between November 2019 and July 2020, 1464 learners enrolled from 114 countries. Overall, 199 individual learners provided a total of 1097 responses to the prompts. The diverse perspectives describe unique challenges present in different contexts including ill-defined roles for pharmacists and nurses in AMS; inadequate governance and policy inconsistencies in surveillance for antibiotic consumption and antimicrobial resistance (AMR) in some countries; lack of ownership of antibiotic decision-making and buy-in from different clinical specialties; and human resource and technological constraints. Patients' knowledge, experiences and perspectives were recognized as a valuable source of information that should be incorporated in AMS initiatives to overcome cultural barriers to the judicious use of antibiotics.

Conclusions: Analysis of learner comments and reflections identified a range of enablers and barriers to AMS implementation across different healthcare economies. Common challenges to AMS implementation included the role of non-physician healthcare workers, resource limitations, gaps in knowledge of AMR, and patient engagement and involvement in AMS.