Objective
To describe current antimicrobial stewardship program (ASP) in France, both at policy level and at local implementation level, and to assess how ASP leaders (ASPL) worked and prioritised their activities.

Methods
We conducted a qualitative study based on face-to-face semi-structured interviews with healthcare professionals responsible for ASP across five French hospitals. Five infectious disease specialists and one microbiologist were interviewed between April and June 2016.

Results
Stewards had dedicated time to perform ASP activities in two university-affiliated hospitals while in the other hospitals (one university, one general and one semi-private), ASPLs had to balance these activities with clinical practice. Consequently, they had to adapt interventions according to their resources (IT or human). Responding to colleagues' consultation requests formed baseline work. Systematic and pro-active measures allowed for provision of unsolicited counselling, while direct counselling on wards required appropriate staffing. ASPL aimed at increasing clinicians' ability to prescribe adequately and awareness of the unintended consequences of inappropriate use of antibiotics. Thus, persuasive e.g. education measures were preferred to coercive ones. ASPL faced several challenges in implementing ASP: overcoming physicians' or units' reluctance, and balancing the influence of medical hierarchy and professional boundaries.

Conclusion
Beyond resources constraints, ASPLs' conceptions of their work, as well as contextual and cultural aspects, led them to adopt a persuasive and collaborative approach of counselling. This is the first qualitative study about ASP in France exploring stewards' experiences and points of view.