<p><b>OBJECTIVES: </b>To determine what barriers and facilitators to antibiotic stewardship exist within a healthcare facility.</p>
<p><b>SETTING: </b>1300-bed tertiary care private hospital located in the state of Kerala, India.</p>
<p><b>PARTICIPANTS: </b>31 semistructured interviews and 4 focus groups with hospital staff ranging from physicians, nurses, pharmacists and a clinical microbiologist.</p>
<p><b>RESULTS: </b>Key facilitators of antibiotic stewardship (AS) at the hospital included a dedicated committee overseeing appropriate inpatient antibiotic use, a prompt microbiology laboratory, a high level of AS understanding among staff, established guidelines for empiric prescribing and an easily accessible antibiogram. We identified the following barriers: limited access to clinical pharmacists, physician immunity to change regarding stewardship policies, infrequent antibiotic de-escalation, high physician workload, an incomplete electronic medical record (EMR), inadequate AS programme (ASP) physical visibility and high antibiotic use in the community.</p>
<p><b>CONCLUSIONS: </b>Opportunities for improvement at this institution include increasing accessibility to clinical pharmacists, implementing strategies to overcome physician immunity to change and establishing a more accessible and complete EMR. Our findings are likely to be of use to institutions developing ASPs in lower resource settings.</p>
K. Baubie, Shaughnessy, C., Kostiuk, L., Joseph, M. Varsha, Safdar, N., Dr. Sanjeev K. Singh, Siraj, D., Sethi, A., and Keating, J., “Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study.”, BMJ Open, vol. 9, no. 5, p. e026193, 2019.