Work

Evaluating the structure of Antibiotic Stewardship Programme in Emirates Health Services hospitals in the United Arab Emirates

Year: 2025

Type: article

Abstract: Evidence on the structure and implementation of Antibiotic Stewardship Programmes (ASPs) is lacking in the Middle East and North Africa (MENA), including the United Arab Emirates (UAE). This gap is concerning as bacterial antimicrobial resistance (AMR) is increasing alarmingly in the UAE. Antibiotic Stewardship Programmes (ASPs) play a crucial role in combating AMR. This study evaluates the structure of ASP in Emirates Health Services (EHS) hospitals against international standards set by Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). A descriptive mixed-methods case study design was employed, incorporating data triangulation through document reviews, employee surveys, and expert interviews across 12 EHS hospitals. Documents were analyzed using a 3-point Likert scale (1=Not met, 2=Partially met, 3=Fully met) across seven core ASP elements. An online survey adapted from CDC and WHO guidelines was distributed to 385 clinical employees, including physicians, pharmacists, nurses, and lab specialists. Descriptive statistics and non-parametric tests (Mann-Whitney and Kruskal-Wallis) analyzed 5-point Likert scale (1=Strongly Disagree, 2= Partially Disagree, 3= Neutral, 4= Partially Agree, 5= Strongly Agree) survey data, comparing median scores across ASP elements and employee groups, with significance at P<0.05. Qualitative data from semi-structured interviews were thematically analyzed using NVIVO software. Document reviews showed that ASPs at EHS hospitals are centrally managed, with all 12 hospitals meeting most core elements (Mode=3). Variability in median scores highlighted challenges in formalizing programs across facilities. Survey results indicated partial dissemination of all core elements (median=4). Leadership commitment (mean=4.41, SD+1.04) and pharmacy expertise (mean=3.93, SD+1.09) showed higher scores compared to other elements. Significant differences were observed between ASP members and non-members (p<0.05), trained and untrained employees (p<0.001), and across hospitals (p=0.032). Qualitative analysis revealed strong strategic commitment and facility-driven ASP implementation supported by collaborative leadership, tailored education, and provider engagement. Key barriers included a lack of trust in ASP teams, physician resistance, absence of a competency framework, inadequate professional training, and limited access to rapid diagnostics. Despite structural barriers and variability in adoption, EHS demonstrates strong leadership commitment, pharmacist engagement, and strategic implementation of ASP interventions. This first mixed-methods study in the UAE, utilizing data triangulation, benchmarks ASP practices against CDC standards. Findings align with practices in non-EHS government hospitals and high-income countries like Norway and Germany but contrast with some MENA region trends. EHS has established a robust foundation for sustainable ASPs, evidenced by adequate adoption and alignment with international frameworks. This study contributes to regional ASP benchmarking and highlights the need for further research to evaluate cost-effectiveness and clinical outcomes, including reductions in mortality and morbidity.

Source: International Journal of Infectious Diseases

DOI: 10.1016/j.ijid.2024.107581

Authors: Ms Fatma Al Hamidh, Dr. Md. Hafizur Rahman, Dr. Esmita Charani

Institutions: Hamdan Bin Mohammed Smart University, University of Liverpool, University of Cape Town, Groote Schuur Hospital

Language: English

Topic: Antibiotic Use and Resistance

Subfield: Applied Microbiology and Biotechnology

Field: Immunology and Microbiology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,900