Optimizing Antibiotics

Antimicrobial stewardship interventions, medical work and resistant microbes in the Spanish public hospital

The project investigates antimicrobial stewardship interventions in Spanish public hospitals, which are known as Programas de Optimización de Antimicrobianos (PROAs). Antimicrobial stewardship is one of the main biomedical interventions being implemented to mitigate the problem of antimicrobial resistance (AMR) in diverse healthcare settings across the world. This research is based on a multi-sited ethnography (carried out between 2021-2023) of these medical interventions in public hospital settings within the Spanish context, and aims to investigate PROAs using an experimental mix of historical and ethnographic methods, including the use of archival materials in in-depth ethnographic interviews and ethnographically documenting visits to the archives.

With the project “Optimizing antibiotics” the aim is to produce an extensive understanding of how clinicians, clinical microbiologists, hospital pharmacists and other hospital professionals coordinate their work to design and implement PROAs by using technologies, materials and work relationships available to them in their workplaces. The main theoretical questions that will be addressed include: what antecedents do these interventions have in the history of Spanish biomedicine since the 1970s; how is the objective of optimization understood and achieved in Spanish antimicrobial stewardship interventions; how are existing hospital materials, infrastructures and labour coordinated to that end; and how do ‘resistant’ microbes emerge as knowledgeable and governable in and through PROAs.

The work will extend decisive observations on the practices of hospital epidemiology, and biomedicine’s attempts to know and control the hospital environment and its human and microbial socialities.