Antibiotic Stewardship in Ambulatory Care Settings

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (31 March 2025) | Viewed by 1246

Special Issue Editors


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Guest Editor
Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA
Interests: healthcare-associated infections; antimicrobial stewardship; antimicrobial resistance; quality improvement

E-Mail Website
Guest Editor
Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
Interests: infection control; epidemiology; fungal infections; antibiotic prescribing

Special Issue Information

Dear Colleagues,

Antimicrobial stewardship has become increasingly important due to the continuous global rise in antimicrobial resistance. Historically, the main focus has been on stewardship in inpatient acute care settings, but stewardship in ambulatory settings is receiving growing attention as another critical area for improving appropriate prescribing.  Recent studies have evaluated prescribing practices in both pediatric and adult populations, frequently with a focus on inappropriate antibiotic use in respiratory infections. Primary care practices and urgent care facilities have been the most common settings for stewardship evaluations, although subspecialty contributions to antibiotic prescribing should also be considered. The recent COVID-19 pandemic and an associated increase in the prevalence of telemedicine visits have also been assessed for their impact on prescribing rates. Appropriate antibiotic selection and duration for other common etiologies of ambulatory visits, including urinary tract infections, skin and soft tissue infections, and sexually-transmitted infections, is another potential focus in the outpatient setting. Much of the previous work has focused on the administration of oral antibiotics, but the appropriateness of IM/IV antibiotics in outpatient settings and the expansion of OPAT programs for associated monitoring also merit attention. The association of outpatient antibiotic utilization with healthcare-associated infections, including C. difficile, and with antibiotic resistance development should also be considered. For this Special Issue, we are looking for submissions addressing the evaluation of antibiotic prescribing and the implementation of antimicrobial stewardship interventions in ambulatory settings. 

Dr. Mary Elizabeth Sexton
Dr. Sharon V. Tsay
Guest Editors

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Keywords

  • ambulatory antimicrobial stewardship
  • antimicrobial resistance

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Published Papers (1 paper)

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9 pages, 173 KiB  
Brief Report
A Pilot Study on Understanding the Contextual Factors Impacting the Implementation of an Antibiotic Stewardship Program in a Single Health Center Serving Rural and Underserved Communities in the United States—A Mixed-Methods Approach
by Arinze Nkemdirim Okere, Anthony Ryan Pinto and Sandra Suther
Antibiotics 2025, 14(3), 263; https://doi.org/10.3390/antibiotics14030263 - 5 Mar 2025
Viewed by 742
Abstract
Objective: This study aimed to identify contextual factors influencing the implementation of an antibiotic stewardship program (ASP) in a rural primary care center serving underserved communities. Methods: A mixed-methods approach guided by the Consolidated Framework for Implementation Research (CFIR) was employed. [...] Read more.
Objective: This study aimed to identify contextual factors influencing the implementation of an antibiotic stewardship program (ASP) in a rural primary care center serving underserved communities. Methods: A mixed-methods approach guided by the Consolidated Framework for Implementation Research (CFIR) was employed. Data were collected through semi-structured interviews, focus groups, and surveys with clinical staff and leadership at a Federally Qualified Health Center (FQHC). The CFIR framework was used to explore barriers and facilitators within the clinic’s inner and outer settings, focusing on staff perceptions, challenges, and readiness for ASP implementation. Results: Strong staff support for ASPs was identified, with participants emphasizing their potential to improve patient outcomes and antibiotic prescribing practices. Barriers included insufficient training, a high workload, and patient pressure to prescribe antibiotics. Leadership commitment, enhanced communication systems, and tailored educational materials were identified as critical facilitators for successful implementation. Participants highlighted the need for accessible educational tools and streamlined protocols to improve engagement and compliance. Conclusions: Implementing an ASP in rural and underserved settings is feasible but requires addressing site-specific challenges. The insights from this study underscore the importance of understanding contextual factors to inform evidence-based strategies for ASP adoption. The structured use of CFIR provided a comprehensive framework to guide implementation efforts, ultimately supporting better antibiotic use and public health outcomes in resource-constrained healthcare settings. Full article
(This article belongs to the Special Issue Antibiotic Stewardship in Ambulatory Care Settings)
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