Barriers and facilitators to implementing antimicrobial stewardship (AMS) in a Chinese tertiary hospital: a qualitative study based on the Consolidated Framework for Implementation Research (CFIR)

Although current evidence supports the effectiveness of antimicrobial stewardship (AMS), its sustained and effective implementation in tertiary hospitals remains challenging. This study aims to explore the facilitative and barrier factors influencing AMS implementation in a Chinese tertiary hospital, thereby providing insights to support the ongoing and effective promotion of AMS within tertiary healthcare institutions. Based on the Consolidated Framework for Implementation Research (CFIR), semi-structured interviews were conducted with 28 key stakeholders, including 15 physicians, 5 hospital managers, 4 pharmacists, 2 nurses, and 2 microbiologists. Data collection continued until data saturation was reached, defined as the point at which no new themes emerged across at least two consecutive interviews. The interview data were analyzed using directed content analysis to systematically code and categorize factors. Textual data were coded and categorized with NVivo 15 software. This study identified 34 facilitative factors, 41 barrier factors, and 1 mixed determinant across 30 CFIR constructs. The distribution of these factors across the CFIR domains is uneven, with a marked concentration observed within the inner setting domain. Key facilitative factors include the establishment of a closed-loop management system, national policy support, multidisciplinary collaboration, and integration of clinical pharmacists into clinical departments. In contrast, major barrier factors include limited clinical adaptability of AMS programs, ambiguous role definition, insufficient available resources, insufficient relative priority, lagging policy management, challenges in interdepartmental collaboration, limited role perception among nurses, and limited knowledge of antibacterial agents among frontline physicians. By synthesizing the identified facilitative and barrier factors, this study suggests that sustainable AMS advancement in tertiary hospitals requires multi-dimensional alignment. While national policy and institutional measures facilitate AMS implementation, its long-term delivery still faces multiple challenges. These findings identify key constraints and provide empirical evidence for optimizing AMS in similar healthcare settings to support its long-term success.