Views and experiences of Antimicrobial Stewardship interventions in paediatric secondary care settings: A Qualitative Evidence Synthesis

Objectives Injudicious use of antimicrobial agents contributes to antimicrobial resistance. Antimicrobial Stewardship (AMS) interventions use strategies derived from evidence-based practices to ensure careful use of antibiotics. AMS is less common in paediatrics as compared to adult practice. As AMS success depends on organizational factors and individual behaviours, this study synthesizes the existing qualitative evidence exploring key barriers, facilitators, and acceptability of AMS. Methods Design A systematic search of primary qualitative studies was conducted in electronic databases. Data sources MEDLINE, PsychINFO via OVID, CINAHL electronic database and handsearching of grey literature sources was done. Eligibility criteria Qualitative studies exploring parents” and/or clinicians” (doctors and nurses) views, attitudes, beliefs, and knowledge on antimicrobial stewardship programmes in paediatric and neonatal hospitals. Data extraction and synthesis Quality appraisal was done using the Critical Appraisal Skills Programme (CASP) tool for qualitative studies. The extracted data was then synthesised by drawing on meta-ethnography. Results A total of 6 studies met the inclusion criteria. 5 studies reported the views and experiences of doctors and nurses, and 1 study reported those of parents. The perceived value of AMS differed in neonatal and paediatric contexts. Structural barriers like resource allocation and hospital organization were a barrier to implementation and acceptability. Nurses reported a lack of formal education about AMS as a barrier. Conclusion/Implications The factors affecting AMS in paediatric secondary care vary with the stakeholders in question. This review identifies some of the factors that can be used to formulate service-level AMS interventions and programmes. Strengths and limitations of the study This is the first evidence synthesis of the qualitative literature exploring the beliefs and experiences of parents and clinicians regarding paediatric AMS. The facilitators and barriers were identified from themes representative of all the included studies, increasing their validity. While included studies were conducted across six countries, all were within the developed world which could limit the generalisability of the findings. A limited number of studies was included due to limited number of primary studies conducted in this area. Original protocol from PROSPERO Registration number: CRD42022346842 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022346842 The process for data synthesis was changed from thematic analysis to meta-ethnography to accommodate the variety of ways in which the results were reported in the included studies.