Optimising the Responsible Use of Antibiotics in Hospitals

Supervisors: Professor Craig Ramsay (Health Services Research Unit), Dr Eilidh Duncan (Health Services Research Unit), Dr Magdalena Rzewuska (Health Services Research Unit) and Professor Louise Locock (Health Services Research Unit)

Antibiotic resistance is a major global public health and patient safety threat. It is associated with severe infections, complications, longer hospital stays, increased mortality and thus increased health care cost (De Kraker et al 2011). Currently the spread of drug-resistant infections is responsible for 700,000 deaths annually and it is projected to cost ten million lives per year by 2050, with an estimated cumulative cost of 100 trillion USD. The core of the problem is:

(1) overuse/inappropriate use of antibiotics in both primary and secondary care, driving development of resistance;

(2) rapid spread of resistant bacteria, locally through insufficient infection control and public health, and worldwide through travel; and

(3) scarce development of new antibiotic agents.

Infections caused by multidrug-resistant bacteria are associated with high mortality, prolonged hospital stay, and increased costs. The increased costs arise partially from the need to use more expensive antibiotic therapy, but the longer hospital stay and expenses related to screening, surveillance, containment, and eradication of drug-resistant organisms account for the majority of the excess costs.

Antibiotic stewardship programmes in hospitals aim to ensure correct and effective antibiotic treatment of patients with infections and minimise collateral damage from antibiotic use. Furthermore, a robust antibiotic stewardship programme is seen as a key component to reduce healthcare associated infections and improve patient safety.

There is important research required to optimise the design and delivery of stewardship programmes and to develop impactful stewardship programmes. Antibiotic stewardship requires clinicians to change their infection control behaviours. The extent to which current antibiotic stewardship programs have incorporated insights and approaches from behavioural science is uncertain. There is, therefore, an urgent need to bring together key insights from behavioural, improvement and social sciences into this area. This includes investigating the barriers and facilitators to implement stewardship programmes in hospitals and designing interventions to overcome these, investigating the role and impact of government policy and context, and exploring patient involvement in efforts to optimise antibiotic stewardship in hospitals. Health care professionals may be particularly interested in establishing a core outcome set to evaluate the effects of stewardship interventions or defining who does what in an antibiotic stewardship programme and in its clinical team. Relevant skills could include systematic reviewing, synthesis of qualitative data, intervention design, qualitative data collection and an interest in behavioural theory. The outcome of the project is expected to have important practical implications for research and/or health care delivery.

Application:

Please select ’Degree of Doctor of Philosophy in Human Nutrition (Medicine)’ from the list of programme options in the University of Aberdeen’s online postgraduate applicant portal to ensure that your application is passed to the correct school for processing. Then manually enter the name of the supervisor(s), project title and funder (Elphinstone) in the space provided.