{
  "abstract": "Background\n\nAntimicrobial stewardship (AMS) programmes are essential for responding to antimicrobial resistance, yet implementation at scale remains challenging everywhere, including in South Africa. This study explored the landscape for driving AMS implementation, identified barriers and enablers and identified priorities for subsequent multi-facility interventions.Methods\n\nPhase 1 of a prospective, multi-phased mixed-methods study used participatory action research informed by the Breakthrough Series methodology and Theory U. Health professionals from public and private sectors participated in workshops in Cape Town and Johannesburg. Activities included mapping individual AMS journeys, identifying barriers and enablers at individual, institutional/facility and national/provincial levels, conducting a SWOT analysis and prioritizing potential AMS implementation projects. Data were analysed using descriptive content analysis.Results\n\nParticipants identified substantial enabling factors alongside persistent barriers. Key enablers included mentorship, multidisciplinary collaboration, management support, functional AMS and infection prevention structures, guidelines, diagnostics, national policies and professional society advocacy. Barriers included professional isolation, weak interprofessional relationships, limited funding and staffing, inadequate training, weak governance, poor data use, fragmented public-private and inter-provincial systems, and inconsistent policy implementation. Strengths were identified as being existing programmes and collaboration, weaknesses as resource and education gaps, opportunities as cross-sector collaboration and technology and threats as limited political support and economic constraints. Eight priority AMS areas were identified as collaborative projects for implementation across multiple healthcare settings.Conclusion\n\nSouth Africa has important existing assets for AMS implementation, although these are unevenly distributed and inconsistently used. Strengthening leadership and collaboration, leveraging existing structures and implementing context-specific countermeasures may support at-scale AMS implementation.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.",
    "Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.",
    "National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.",
    "Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.",
    "Department of Paediatrics, University of Pretoria, Pretoria, South Africa.",
    "Digital Medication Management, Netcare Group Ltd, Johannesburg, South Africa.",
    "Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.",
    "Department of Pharmacology, University of Pretoria, Pretoria, South Africa.",
    "Division of Family Medicine, Department of Family, Community and Emergency Care, University of Cape Town, Cape Town, South Africa."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Dena Van Den Bergh",
      "orcid": "0000-0003-4057-4925"
    },
    {
      "affs": [
        0
      ],
      "name": "Esmita Charani",
      "orcid": "0000-0002-5938-1202"
    },
    {
      "affs": [
        0
      ],
      "name": "Candice Bonaconsa",
      "orcid": "0000-0002-3773-8522"
    },
    {
      "affs": [
        1,
        2,
        3
      ],
      "name": "Adrian Brink",
      "orcid": "0000-0002-5350-9690"
    },
    {
      "affs": [
        4
      ],
      "name": "Nicolette Du Plessis"
    },
    {
      "affs": [
        5
      ],
      "name": "Angeliki Messina"
    },
    {
      "affs": [
        6
      ],
      "name": "Malcolm Miller"
    },
    {
      "affs": [
        7
      ],
      "name": "Natalie Schellack",
      "orcid": "0000-0001-9690-6285"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Hafsah Tootla",
      "orcid": "0000-0002-7322-8060"
    },
    {
      "affs": [
        8
      ],
      "name": "Klaus B Von Pressentin",
      "orcid": "0000-0001-5965-9721"
    },
    {
      "affs": [
        0
      ],
      "name": "Marc Mendelson"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fm11wj6zkqsax.bib",
  "cited_by": 0,
  "doi": "10.1093/jacamr/dlag232",
  "fulltext_url": "https://europepmc.org/articles/PMC13687901",
  "id": "fm11wj6zkqsax",
  "issns": [
    "2632-1823"
  ],
  "landing_url": "https://europepmc.org/article/MED/42923216",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2402|Antibiotic Use and Resistance"
    ]
  ],
  "openalex": "W7223179248",
  "pdf_url": "https://europepmc.org/articles/PMC13687901?pdf=render",
  "pmcid": "PMC13687901",
  "pmid": "42923216",
  "published": "2026-10-22",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/fm11wj6zkqsax.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:33Z",
      "native_id": "MED:42923216",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42923216"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "openalex:2402|Antibiotic Use and Resistance",
      "subfield": "microbiology"
    }
  ],
  "title": "Understanding the landscape for driving antimicrobial stewardship implementation at scale in South Africa.",
  "title_text": "Understanding the landscape for driving antimicrobial stewardship implementation at scale in South Africa.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:33Z",
  "url": "https://research.draconitic.com/paper/fm11wj6zkqsax",
  "venue": "JAC-antimicrobial resistance",
  "versions": []
}