I am Rasha Abdelsalam Elshenawy, I am a Clinical Pharmacist by background doing my PhD at the University of Hertfordshire in the UK. I am an Antimicrobial Stewardship Global Lead. I have an American Board of Pharmacy with 20 years of experience, and I am certified in Antimicrobial Stewardship. I have special interests in antimicrobial resistance (AMR) and antimicrobial stewardship (AMS). I led AMS and put measures against antibiotic-resistant bacteria and Five-years AMS strategic plan.

I am a director of FADIC Antimicrobial Stewardship School, which was shortlisted for the Antibiotic Guardian award (2020). This school was shared in the Centre for Disease Control and Prevention (CDC) AMR challenge in 2018. Realising the global burden of AMR has fulfilled my passion for finding possible solutions to AMR through effective implementation of AMS and improving antibiotic prescribing and education

• The World Antibiotic Awareness Week (WAAW) highlights the importance of responsible antibiotic use and education on antimicrobial resistance and antimicrobial stewardship.
• The urgency to combat an AMR has never been greater. With projections of 10 million deaths annually by 2050 due to AMR, the importance of antibiotic awareness is paramount.
• My experience conducting AMR research at Bedfordshire Hospitals NHS Foundation Trust has been pivotal in understanding this crisis.
• I extend heartfelt thanks to the antimicrobial stewardship pharmacists at the Trust. Their collaboration in promoting AMR research has been invaluable. Likewise, the Research and Development (R&D) department within the Trust deserves recognition for their support in my PhD research project, which investigated antimicrobial stewardship before and during the COVID-19 pandemic.
• The invaluable contributions at Bedfordshire Hospitals NHS Foundation Trust have been made by a team of dedicated professionals, including AMS pharmacists (Faisal Khan, Abdul Mohamed, and Suraiya Chandratillake), Chief Pharmacist  (Pritesh Bodalia), Head of Pharmacy at Luton & Dunstable University Hospital (Ravi Sharma), Head of Pharmacy at Bedford Hospital (Gemma McGuigan), AMS Lead, and Microbiology Consultant (Dr Mulla Rohinton).
• The Research & Development (R&D) department, with Assistant Director of R&D (Dr. Mohammad Wasil), and Manager of Research and Development (Margaret Louise Tate), have also played a crucial role.
• Acknowledgements extend to the former lead specialist pharmacist in training and development (Patricia Edwards), as well as the Trust's communication team.
• Their support and assistance have been pivotal in maintaining the success of our research. From reviewing retrospective medical records to conducting prospective surveys among healthcare professionals, their contributions have significantly shaped the comprehensive outcomes of our research. This collaboration promotes an integerated antibiotic prescribing and antimicrobial stewardship investigation, thereby fostering antimicrobial stewardship and combating antimicrobial resistance (AMR).
• I am also grateful to the University of Hertfordshire, School of Life and Medical Sciences, for sponsoring this research. The support from university supervisors (Prof Zoe Aslanpour and Dr Nkiruka Umaru) and the statistical support department has maintained the quality and excellence of the research. 

Key takeaways from this sustainable research project include:

1. A multidisciplinary team is essential for a consistent, integrated research project.
2. Collaboration between academia and NHS trusts is crucial for evidence-based research to address AMR.
3. Future AMR research is vital for developing integrated tools and understanding the necessary elements for effective AMS implementation.
4. Healthcare professionals are committed to proper antibiotic use, but clinical judgment and practice situations can be challenging.
5. Antimicrobial stewardship is more than judicious antibiotic use; it's a lifestyle in clinical practice.
6. The output of this research is a comprehensive roadmap for AMS implementation, including dynamic dashboards and educational programs.
7. The COVID-19 pandemic has highlighted the impact of AMR on mortality.
8. The loss due to antibiotic misuse highlights the urgent need for rational antibiotic use.

In conclusion, my gratitude goes to the AMS team at Bedfordshire Hospitals NHS Foundation Trust for their support throughout my academic journey and the University of Hertfordshire. Their dedication has not only aided my research but also contributes significantly to the global fight against AMR.

Dissemination of this Research Project

• An investigation into the effectiveness of antimicrobial stewardship during a pandemic- COVID-19 in acute care setting: Published in Prospero.
• Antimicrobial stewardship before and during the COVID-19 pandemic: Possible solution to antimicrobial resistance: Published ISRCTN Medicine Blog.
• Antimicrobial stewardship implementation before and during the COVID-19 pandemic in the acute care settings: A systematic literature review.
• Antimicrobial Stewardship Implementation Before and During the COVID-19 Pandemic in Acute-care settings: Published in Springer Community related to the United Nations sustainable goals.
• Antimicrobial stewardship implementation before and during the COVID-19 pandemic: Published in WHO AMR Exchange on Antimicrobial Stewardship & COVID-19.
• How did the COVID-19 pandemic impact antibiotic prescribing and antimicrobial stewardship in acute care settings?: Published in Octopus.
• An investigation into factors affecting antibiotic use during the COVID-19 pandemic in two hospitals: Published in ISRCTN related to WHO criteria.
• WHO AWaRe classification for antibiotic stewardship: tackling antimicrobial resistance – a descriptive study from an English NHS Foundation Trust prior to and during the COVID-19 pandemic: Published in Frontiers Microbiology.
  
• Shorter and Longer Antibiotic Durations for Respiratory Infections: To Fight Antimicrobial Resistance—A Retrospective Cross-Sectional Study in a Secondary Care Setting in the UK: Published in MDPI Pharmaceuticals.
• Impact of COVID-19 on ‘Start Smart, Then Focus’ Antimicrobial Stewardship at One NHS Foundation Trust in England Prior to and during the Pandemic: Published in MDPI COVID. Novel survey distribution methods: impact on antimicrobial resistance research outcomes: Published in JAC-Antimicrobial Resistance.

To read the Final Report of the 'COVID-19 Impact on Antimicrobial Stewardship', contact the Principal Investigator, Rasha Abdelsalam Elshenawy.

Email: r.a.elshenawy@herts.ac.uk

Publication Date: 23 November 2023.