PT - JOURNAL ARTICLE AU - Kelsey Baubie AU - Catherine Shaughnessy AU - Lia Kostiuk AU - Mariam Varsha Joseph AU - Nasia Safdar AU - Sanjeev K Singh AU - Dawd Siraj AU - Ajay Sethi AU - Julie Keating TI - Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study AID - 10.1136/bmjopen-2018-026193 DP - 2019 May 01 TA - BMJ Open PG - e026193 VI - 9 IP - 5 4099 - http://bmjopen.bmj.com/content/9/5/e026193.short 4100 - http://bmjopen.bmj.com/content/9/5/e026193.full SO - BMJ Open2019 May 01; 9 AB - Objectives To determine what barriers and facilitators to antibiotic stewardship exist within a healthcare facility.Setting 1300-bed tertiary care private hospital located in the state of Kerala, India.Participants 31 semistructured interviews and 4 focus groups with hospital staff ranging from physicians, nurses, pharmacists and a clinical microbiologist.Results Key facilitators of antibiotic stewardship (AS) at the hospital included a dedicated committee overseeing appropriate inpatient antibiotic use, a prompt microbiology laboratory, a high level of AS understanding among staff, established guidelines for empiric prescribing and an easily accessible antibiogram. We identified the following barriers: limited access to clinical pharmacists, physician immunity to change regarding stewardship policies, infrequent antibiotic de-escalation, high physician workload, an incomplete electronic medical record (EMR), inadequate AS programme (ASP) physical visibility and high antibiotic use in the community.Conclusions Opportunities for improvement at this institution include increasing accessibility to clinical pharmacists, implementing strategies to overcome physician immunity to change and establishing a more accessible and complete EMR. Our findings are likely to be of use to institutions developing ASPs in lower resource settings.