Facilitators and barriers when implementing antibiotic stewardship interventions in neonates at risk of early-onset sepsis

INTRODUCTION: Antibiotic stewardship is becoming increasingly important in neonatal care. This is particularly the case for managing early-onset sepsis (EOS), given the impact on hospitalization, short- and long-term health, and antibiotic resistance. Despite the available evidence supporting various antibiotic stewardship interventions to reduce antibiotic use, evidence regarding their implementation remains limited. AIM: This study aimed to identify barriers and facilitators of implementing three evidence-based antibiotic stewardship interventions in EOS care: the EOS calculator, procalcitonin (PCT)-guided therapy, and IV-to-oral switch therapy. METHODS: Eleven semi-structured focus group interviews were conducted with 81 participants, including pediatricians, neonatal nurses, pediatric residents, midwives, primary care maternity nurses, microbiologists, pharmacists, and general practitioners. The Consolidated Framework for Implementation Research (CFIR), with its five domains (intervention characteristics, outer setting, inner setting, individual characteristics, and implementation process), was used for data collection and analysis. A rapid deductive content analysis approach was used. RESULTS: The interviews identified 34 barriers, mostly found in the inner setting (n = 11), intervention characteristics (n = 10), and the individual health professional level (n = 8). Twenty facilitators were identified, mostly related to intervention characteristics (n = 8). The overarching barriers were identified as external pressure to adhere to the national guidelines and the expected shift in care responsibility. Facilitators identified unanimously by all participants included universal dissatisfaction with the current national guidelines, a hospital culture of evidence-based and patient-centered care, and the presence of a strong opinion leader. CONCLUSION: Implementation strategies should address these barriers and facilitators, seeking to balance quality of evidence with professional core values, managing shifts in care, enhancing interdisciplinary communication, and reducing practice variation by addressing dissatisfaction with un-updated guidelines at an earlier stage.