Where To From Here? Identifying and Prioritizing Future Directions for Addressing Drug-Resistant Infection in Australia

Abstract

Background: The Australian Government released a national strategy for antimicrobial resistance in 2015 that calls for a collaborative effort to change practices that have contributed to the development of drug-resistant infection and for the implementation of new initiatives to reduce antibiotic use. Although many achievements have been made in antimicrobial stewardship (AMS), particularly in the acute-care hospital setting, progress more broadly has been slow, and novel solutions are now required to improve clinical practice and community awareness. A facilitated workshop was undertaken at the 2019 National Australian Antimicrobial Resistance Forum to explore the complexity of AMS implementation in Australia and to prioritize future action. Methods: Participants engaged in rotating rounds of discussion using a world café format. The participants sat face-to-face at tables of 7 or fewer. At each table were 2 facilitators: one was a note taker and the other was the discussion leader. Each of the 6 facilitator pairs had a topic for discussion related to implementing antimicrobial stewardship in different contexts, with a focus on experience with strategies that have worked, major implementation barriers, and prioritizing the next steps. The topics for discussion included (1) engaging with hospital staff; (2) implementation in resource-poor settings; (3) implementation in primary care and aged care; (4) engaging and empowering the public; (5) linking data with implementation strategies; and (6) leadership. The facilitators moved between tables at 15-minute intervals to encourage evolving rounds of conversation. Once all tables had discussed all of the themes, the discussion concluded and notes were summarized. A qualitative analysis using an interpretive description approach was conducted using the discussion summaries. The documents were independently openly coded by 2 researchers to identify elements relating to the implementation of antimicrobial stewardship. An iterative approach was used to identify themes and reach a consensus on overarching emergent themes from the workshop. Results: In total, 39 experts (ie, pharmacists, infectious disease physicians, infection prevention nurses, researchers, journalists and consumers) participated in the facilitated discussions. Strategies were discussed relating to engaging with clinicians, consumers, and politicians; adapting to funding, governance, and accreditation limitations; and models for outreach of antimicrobial services. Other themes included the role of clinical champions and mentors as leaders and improving use of audit and feedback through focusing on monitoring appropriateness rather than usage. Conclusions: Recommendations from the workshop will be used to prioritize novel ideas to improve the implementation of AMS initiatives across Australia.Funding: NoneDisclosures: None