Facilitators and barriers when implementing antibiotic stewardship interventions in neonates at risk of early-onset sepsis

IntroductionAntibiotic stewardship is becoming increasingly important in neonatal care, given the impact of early antibiotic use on hospitalisation, short- and long-term health, and antibiotic resistance. To tackle these challenges, various antibiotic stewardship interventions have been developed. While neonatal early-onset sepsis (EOS) interventions have demonstrated potential to reduce and optimize antibiotic use, evidence regarding their implementation remains limited. In this study we aimed to identify barriers and facilitators of implementing three evidence-based antibiotic stewardship interventions in EOS care. MethodsInterdisciplinary focus group interviews were conducted with paediatricians, neonatal nurses, paediatric residents, midwives, primary care maternity nurses, microbiologists, pharmacists, and general practitioners. A semi-structured interview guide was used to discuss the EOS calculator, PCT-guided therapy, IV-oral switch therapy and current EOS care practices. The Consolidated Framework for Implementation Research (CFIR), consisting of 5 determinant domains (innovation, outer setting, inner setting, individuals, and implementation process domain), was used to guide the interviews and data analyses, using a rapid deductive content analysis approach. ResultsEleven focus group interviews were conducted with 81 participants. We identified 34 barriers and 20 facilitators. Most barriers concerned the inner setting (n=11), intervention characteristics (n=10), and the individual health professional level (n=8), while most facilitators were related to the intervention characteristics (n=8). Overarching barriers for implementing novel antibiotic stewardship interventions were external pressure to adhere to the national guidelines or affiliated academic regional protocols and the expected care shift towards healthcare workers with an already high workload. Universal dissatisfaction with the current national guideline and a hospital culture of evidence-based, patient-centred care in the presence of a strong opinion leader were reported as facilitators of implementing antibiotic stewardship interventions. ConclusionThis study identified barriers and facilitators influencing the implementation of three antibiotic stewardship interventions in neonatal EOS care. These determinants can be consolidated in the following themes: balancing quality of evidence with professional core values, managing care shifts and enhancing interdisciplinary communication, and conflicts with un-updated guidelines.