Gaps and Barriers to the Implementation of Antimicrobial Stewardship Programmes in Hospitals of Pakistan.

Antimicrobial-resistant bacteria are particularly prevalent in Southeast Asia, mainly due to inadequate infection prevention and control (IPC) and the widespread and uncontrolled use of antibiotics. Pakistan is the third largest low-middle-income country (LMIC) user of antibiotics. Antibiotic consumption increased by 65%, from 800 million to 1.3 billion defined daily doses (DDD). Antimicrobial consumption is high and poorly regulated, and an estimated 300,000 people die because of bacterial antimicrobial resistance (AMR) annually. Due to the changing government priorities, antimicrobial stewardship programmes (ASP) implementation is not compulsory for hospitals to acquire national accreditation, which has led to de-prioritisation among hospital managers and clinical teams. Additionally, lack of support from hospital administration, limited nationwide health insurance coverage for bacterial cultures, and a lack of surgical centres and microbiology laboratories, information technology (IT) support to collect and analyse AS-related data, reduced availability of pharmacists, ID physicians, and IPC staff for ASP events are the primary contributing factors creating hindrance to the long-term viability of ASP. Briefly, strong hospital leadership support is the major factor for allocating the resources for ASP structures and activities and also for establishing the key performance indicators (KPIs), enforcing compliance with hospital-specific clinical practice guidelines, as well as addressing friction between ASP team members and prescribers. Key Words: Antimicrobial resistance, Antimicrobial stewardship programmes, Infection prevention and control.