Predictors of acceptance of antimicrobial stewardship interventions in a multidisciplinary program: a retrospective community hospital study

Abstract

Abstract Objective: Although antimicrobial stewardship programs (ASPs) have been shown to improve antibiotic prescribing and reduce antimicrobial resistance, evidence from community hospitals remains scarce, particularly regarding the determinants of acceptance of ASP recommendations. This study aimed to evaluate the acceptance of ASP interventions in a community hospital and to identify the factors associated with their acceptance. Design: Retrospective observational study. Setting: A 113-bed community hospital in Spain. Participants: Hospitalized patients receiving or considered for antimicrobial treatment who were reviewed through a prospective audit and feedback between July 2021 and February 2024. Methods: ASP interventions were prospectively collected in a structured database. Bivariate analyses and a multivariable logistic regression were performed to evaluate factors associated with recommendation acceptance. Results: A total of 437 ASP interventions were recorded. Acceptance was documented for 343 interventions (78.5%), of which 264 were accepted (77.0%). In bivariate analysis, acceptance was associated with clinical service, source of infection, microbiological culture, antimicrobial indication, type of ASP recommendation, age, and white blood cell count. In the multivariable analysis (n = 343), clinical service remained the only variable independently associated with acceptance among those included in the model. Interventions targeting surgical services were significantly less likely to be accepted compared with medical services (adjusted OR, 0.28; 95% CI, 0.12–0.64; P = .002). Conclusions: Acceptance of ASP interventions in a community hospital varied significantly by clinical service, with lower acceptance in surgical services. These findings support tailoring antimicrobial stewardship strategies to specific clinical contexts.