{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:34:09Z","timestamp":1787243649272,"version":"build-2736575974"},"reference-count":35,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004242","name":"Princess Nourah bint Abdulrahman University","doi-asserted-by":"publisher","award":["PNURSP2026R485"],"award-info":[{"award-number":["PNURSP2026R485"]}],"id":[{"id":"10.13039\/501100004242","id-type":"DOI","asserted-by":"publisher"}]},{"award":["PNURSP2026R485"],"award-info":[{"award-number":["PNURSP2026R485"]}],"id":[{"id":"https:\/\/ror.org\/05b0cyh02","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Clinical pharmacists contribute pharmacotherapy expertise to antimicrobial stewardship (AMS), but antimicrobial prescribing remains a multidisciplinary process led by treating clinicians. In physician-centered hospital systems, pharmacists\u2019 contributions may be integrated into prescribing decisions to varying degrees depending on the organizational structures, interprofessional relationships, workflow integration, and prescribing cultures. This study aimed to explore how contextual and interprofessional factors shape the integration of clinical pharmacists\u2019 antimicrobial stewardship contributions within multidisciplinary prescribing decisions in Jordanian hospitals. Methods: A multi-site qualitative study was conducted across nine Jordanian hospitals. Semi-structured interviews were conducted with 26 clinical pharmacists involved in antimicrobial reviews in intensive care and general medical units. Interviews incorporated the critical incident technique to elicit examples of accepted and rejected stewardship recommendations. Data were analyzed using a realist-informed approach to develop context\u2013mechanism\u2013outcome configurations explaining variations in pharmacists\u2019 reported AMS contribution. Results: Pharmacotherapy expertise was necessary but not sufficient for pharmacists\u2019 recommendations to shape antimicrobial prescribing. Leadership endorsement, structured multidisciplinary rounds, and formal documentation pathways activated mechanisms of legitimacy, credibility, and workflow visibility, supporting reported uptake of dose optimization, therapeutic drug monitoring, and selected de-escalation recommendations. In contrast, prescriber-led hierarchies, limited documentation pathways, workload pressures, and defensive prescribing cultures activated mechanisms of self-limitation, risk aversion, and limited recommendation uptake, particularly for discontinuation, duration control, and narrowing of broad-spectrum therapy. Conclusions: Strengthening AMS requires not only formal committees and guidelines but also team-based structures that integrate pharmacists\u2019 pharmacotherapy expertise into antimicrobial review while preserving clinicians\u2019 ultimate prescribing responsibility.<\/jats:p>","DOI":"10.3390\/antibiotics15070670","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T17:27:31Z","timestamp":1783531651000},"page":"670","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Contextual Determinants of Clinical Pharmacists\u2019 Contributions to Team-Based Antimicrobial Stewardship in Jordanian Hospitals: A Realist-Informed Qualitative Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Mona","family":"Bustami","sequence":"first","affiliation":[{"name":"Faculty of Pharmacy, University of Petra, Amman 11196, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saba Ammar","family":"Alabdali","sequence":"additional","affiliation":[{"name":"Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6002-0287","authenticated-orcid":false,"given":"Mohammad Abu","family":"Assab","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Department, Faculty of Pharmacy, Zarqa University, Zarqa 13132, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2144-0753","authenticated-orcid":false,"given":"Inas","family":"Almazari","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Department, Faculty of Pharmacy, Zarqa University, Zarqa 13132, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wafa\u2019 A.","family":"Al-Haj","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5832-7247","authenticated-orcid":false,"given":"Wael","family":"Abu Dayyih","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Mutah University, Alkarak 61710, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6186-848X","authenticated-orcid":false,"given":"Hayam A.","family":"Alrasheed","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3691-9759","authenticated-orcid":false,"given":"Zainab","family":"Zakaraya","sequence":"additional","affiliation":[{"name":"Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2828-1011","authenticated-orcid":false,"given":"Anas","family":"Abed","sequence":"additional","affiliation":[{"name":"Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Salam, M.A., Al-Amin, M.Y., Salam, M.T., Pawar, J.S., Akhter, N., Rabaan, A.A., and Alqumber, M.A.A. 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