Perceptions of antimicrobial stewardship: identifying drivers and barriers across various professions in Canada utilizing a one health approach

Abstract

Introduction: As antimicrobial resistance (AMR) represents a substantial threat to the efficacy of available antimicrobial options, it is important to understand how to implement effective and practical mitigation efforts, including antimicrobial stewardship (AMS), across human, animal, and environmental sectors.

Methods: A mixed-methods questionnaire was distributed virtually to attendees of the virtual One Health Antimicrobial Stewardship Conference (March 10-12, 2021) and their professional networks. Respondents (n = 81) were largely from the veterinary (75%) or human (19%) health sectors. Qualitative data were analyzed in NVivo using template analysis whereas quantitative data were analyzed in STATA using Kruskall-Wallis tests. The questionnaire asked respondents about their perceptions of AMS, as well as the perceived barriers and drivers of AMS efforts.

Results: Perceptions of what AMS meant to the respondents personally and their profession as a whole were grouped into 3 main themes: 1) AMS strategies or considerations in antimicrobial prescribing and use; 2) responsibility to maintain health and preserve antimicrobial effectiveness; and 3) reducing antimicrobial use (AMU) as a goal of AMS efforts. Identified AMS barriers had 3 main themes: 1) lack of various prescribing and AMU support mechanisms; 2) shift in prescriber attitudes to drive change; and 3) stronger economic considerations to support shifting prescribing practices. Drivers of AMS had the following themes: 1) leadership to guide change; 2) education to support optimizing AMU; and 3) research to identify best practices and opportunities for action. Across all questions, 2 cross-cutting themes emerged: 1) a One Health understanding of AMS; and 2) blame placed on others for a lack of AMS success.

Conclusion: Overall, sector-specific, but particularly cross-sectoral AMS drivers and barriers were identified, highlighting the importance of a One Health approach in AMR research and mitigation.

Keywords: Canada; antimicrobial resistance; antimicrobial stewardship; drivers and barriers; one health.

Figure 1

Flowchart of identified hierarchical themes across participant responses to the open-ended questions: (1) “What does antimicrobial stewardship (AMS) mean to you in your profession?” (n = 74; veterinary sector = 57, human health sector = 15, agricultural sector = 1, both veterinary and human health sector = 1), and (2) “What does antimicrobial stewardship mean to your profession as a whole?” (n = 73; one human health sector participant did not respond). (1) AMS strategies or considerations in antimicrobial prescribing and use, (2) Responsibility to maintain health and preserve antimicrobial effectiveness, (3) Reducing antimicrobial use (AMU) as a goal of AMS efforts.

Figure 2

Flowchart of identified hierarchical themes across participant responses to the open-ended questions about antimicrobial stewardship barriers: “What is preventing antimicrobial stewardship in your profession?” (n = 59; veterinary sector = 47, human health sector = 11, agricultural sector = 1) posed to participants who responded, ‘yes’ to “Do you believe there are barriers in antimicrobial stewardship in your profession?” (1) Lack of various prescribing and antimicrobial use (AMU) support mechanisms, (2) Shift in prescriber attitudes to drive change, (3) Stronger economic considerations to support shifting prescribing practices.

Figure 3

Flowchart of identified hierarchical themes across participant responses to the open-ended questions regarding antimicrobial stewardship drivers: “What is currently in place that helps promote antimicrobial stewardship in your profession?” (n = 47; veterinary sector = 37, human health sector = 10) asked to participants who responded ‘yes’ to “Do you believe there is support in place to promote/encourage antimicrobial stewardship in your profession?” (1) Leadership to guide change, (2) Education to support optimizing antimicrobial use, (3) Research to identify best practices and opportunities for action, *CE = Continuing Education.

Figure 4

Word cloud of the most common responses (n = 67 participants) to the question “Who should take responsibility in promoting antimicrobial stewardship?”