Uncovering the Roadblocks: Challenges to Implementing Antimicrobial Stewardship in Pakistan

Abstract

Background: Antimicrobial resistance (AMR) poses a growing threat to healthcare systems globally, with Pakistan facing disproportionate challenges due to unregulated antibiotic use and limited stewardship infrastructure. Antimicrobial stewardship programmes (ASPs) are essential to optimize antibiotic use, yet their implementation remains inconsistent across Pakistani hospitals. Objective: This study aimed to identify institutional, professional, and systemic barriers to ASP implementation in Pakistani hospitals and assess differences in perceived challenges among healthcare professionals. Methods: A cross-sectional observational study was conducted in urban public and private hospitals across Sindh, Pakistan, between January and February 2025. Two hundred healthcare professionals, including doctors, pharmacists, nurses, and allied health staff, were recruited via stratified random sampling. Data were collected using a validated questionnaire assessing awareness, institutional readiness, and barriers to ASPs. Statistical analysis involved descriptive measures and chi-square tests, with significance set at p < 0.05. Results: Although 85% of participants were aware of ASPs, only 40% had received formal training, and 30% were familiar with national guidelines. Institutional readiness was low, with 35% reporting ASP teams and 30% utilizing microbiology labs for prescribing. Key barriers included lack of trained staff (75%), inadequate lab facilities (70%), and absence of hospital policies (65%). Significant differences in perceived barriers were observed across professional groups (p-values 0.015–0.047). Conclusion: High awareness of ASPs in Pakistan is undermined by substantial institutional and professional barriers, emphasizing the need for targeted training, policy enforcement, and diagnostic infrastructure to ensure effective stewardship implementation.