Barriers to facilitate antimicrobial stewardship of hospital clinicians in Korea: a mixed-methods study using a qualitative study and survey results

BACKGROUND: Antimicrobial stewardship (AS) programs have the potential to improve antibiotic use and mitigate antimicrobial resistance (AMR). However, several challenges hinder the successful implementation of AS programs. The aim of this study was to explore hospital clinicians' perceptions and attitudes toward AS programs, as well as the associated barriers to facilitating their adoption in Korea. METHODS: We conducted both focus group interviews and online surveys. In-depth focus group interviews were held with 14 physicians-comprising three otolaryngologists, three infectious diseases physicians, three pediatricians, three pulmonologists, one family medicine physician and one general surgeon-from three hospitals in South Korea in 2018. Additionally, a web-based survey was distributed to secondary and tertiary hospitals. RESULTS: We identified several key barriers imposed by non-clinical factors, including hierarchical structures within hospitals, physicians' concerns about disease progression, and patients' expectations regarding antibiotics. As a result, participants reported a need for education targeting both patients and physicians. In the survey of 120 respondents, knowledge gaps were found to differ by hospital type and the presence of infectious disease specialists. CONCLUSION: This study examined the enablers and barriers to AS using a mixed-methods approach in Korea. Our findings provide insight into the current status of AS and identify areas where efforts should be focused to promote appropriate antimicrobial use and address barriers to AS.