Unlocking antimicrobial stewardship optimization potential in Canadian hospitals: a mixed-methods needs assessment.

Background: A greater understanding of the enduring challenges associated with the implementation and impact of antimicrobial stewardship (AMS) programmes in Canadian hospitals is needed. Objectives: To identify the gaps and barriers at the individual, team and systemic level affecting the capacity of hospital physicians, microbiologists and pharmacists to diagnose, treat and manage infections in concordance with AMS principles in Canada. Methods: A sequential mixed-method needs assessment was performed, with a qualitative exploratory phase informing a quantitative validating phase. Discrepancy analysis between current and expected measures was performed to identify gaps. Results: Two distinct study samples of hospital healthcare providers (HCPs) were obtained: 20 interviewees and 100 survey completers. Triangulated results demonstrated sub-optimal: (i) competencies of HCPs to follow AMS recommendations and to educate patients on antimicrobial resistance, (ii) competencies of leaders to build capacity and trust in AMS recommendations and (iii) funding and organizational capacity to fully implement AMS strategies. On average, 45% of HCPs had both an educational and behavioural gap relevant to AMS. A sense of distrust towards AMS recommendations was reported by 71% of HCPs. Over half (56%) of HCPs stated that AMS strategies were not fully implemented despite a perception that their practice setting had full AMS funding. Systemic barriers included strained human resources, a lack of specialized personnel and unfavourable performance metrics. Conclusions: This study sheds light on what prevents the integration of AMS strategies in Canadian hospitals. Changes at the educational, organizational and leadership levels are required to fully unlock the potential of AMS.