The drivers of antimicrobial use across institutions, stakeholders and economic settings: A paradigm shift is required for effective optimisation.

A/Prof Jennifer Broom1, Prof Alex Broom2, Dr  Emma Kirby2

1Sunshine Coast University Hospital, , Australia,
2University of New South Wales, , Australia


Significant antimicrobial over-use persists worldwide, despite overwhelming evidence of antimicrobial resistance and knowledge that optimisation of antimicrobial use will slow the development of resistance. It is critical to understand why this occurs. This study aims to consider the social influences on antimicrobial use within hospitals in Australia, via an in-depth, multi-site analysis.


Qualitative multi-site design, involving 222 individual semi-structured interviews and thematic analysis. Participants (85 doctors, 79 nurses, 31 pharmacists, and 27 hospital managers) were recruited from five hospitals in Australia, including four public hospitals (two metropolitan, one regional, one remote), and one private hospital.


Analysis of the interviews identified social relations and institutional structures that may have a strong influence on antimicrobial use, which must be addressed concurrently: 1. Social relations that exist across settings: These include the influence of personal risk, hierarchies, inter and intra-professional dynamics and sense of futility in making a difference long-term in relation to AMR; 2. Institutional structures that offer context-specific influences: These include patient population factors (including socioeconomic factors, geographical isolation, and local infection patterns), proximity and resource issues.


The success of antimicrobial optimisation rests on adequate awareness and incorporation of multi-level influences. Analysis of the problem has tended to emphasise individual ‘behaviour improvement’ in prescribing rather than incorporating the problem of over-use as inherently multidimensional and necessarily incorporating personal, interpersonal and institutional variables. A paradigm shift is urgently needed to incorporate these critical factors in antimicrobial optimisation strategies.


Jennifer Broom is an Infectious Diseases Physician who has a research programme in collaboration with the University of New South Wales investigating the social influences on antimicrobial prescribing.

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