ObjectivesAntibiotic overuse is one of the main drivers of antimicrobial resistance (AMR), especially in low-income and middle-income countries. This study aimed to understand the perceptions and views towards AMR, antibiotic prescribing practice and antimicrobial stewardship (AMS) among hospital physicians in Jakarta, Indonesia.DesignCross-sectional, self-administered questionnaire-based survey, with descriptive statistics, exploratory factor analysis (EFA) to identify distinct underlying constructs in the dataset, and multivariable linear regression of factor scores to analyse physician subgroups.SettingSix public and private acute-care hospitals in Jakarta in 2019.Participants1007 of 1896 (53.1% response rate) antibiotic prescribing physicians.ResultsPhysicians acknowledged the significance of AMR and contributing factors, rational antibiotic prescribing, and purpose and usefulness of AMS. However, this conflicted with reported suboptimal local hospital practices, such as room cleaning, hand hygiene and staff education, and views regarding antibiotic decision making. These included insufficiently applying AMS principles and utilising microbiology, lack of confidence in prescribing decisions and defensive prescribing due to pervasive diagnostic uncertainty, fear of patient deterioration or because patients insisted. EFA identified six latent factors (overall Crohnbach’s α=0.85): awareness of AMS activities; awareness of AMS purpose; views regarding rational antibiotic prescribing; confidence in antibiotic prescribing decisions; perception of AMR as a significant problem; and immediate actions to contain AMR. Factor scores differed across hospitals, departments, work experience and medical hierarchy.ConclusionsAMS implementation in Indonesian hospitals is challenged by institutional, contextual and diagnostic vulnerabilities, resulting in externalising AMR instead of recognising it as a local problem. Appropriate recognition of the contextual determinants of antibiotic prescribing decision making will be critical to change physicians’ attitudes and develop context-specific AMS interventions.

The Exploration of Antimicrobial Consumption to Identify Targets for Quality Improvement in Indonesian Hospitals study showed that 97% of the use of empirical antibiotics was 81% empiric therapy, 12% medical prophylaxis, 4% surgical prophylaxis, and 16% without clear indications. The most common diagnoses are typhoid, pneumonia. and dengue fever. The Antimicrobial Stewardship Programme (ASP) Team supports the national program to reduce the use of irrational antibiotics. This study aims to analyse the ASP policy implementation on the use of antibiotics at the Royal Taruma Hospital. A secondary data on the use of Defined Daily Dose (DDD)/100 patient-days for the quarterly months of February, May, and August 2020. The 14 key informants' perceptions, opinions, thoughts are the primary data of qualitative research on the use of antibiotics during the ASP policy implementation. The three most antibiotics used were Ceftriaxone (64.7%), Levofloxacin (20.1%), and Meropenem (6.9%), which belong to the broad-spectrum antibiotic class. The total use of antibiotics was 1206.59 DDD/100 patient-days. The implementation of ASP policies has not been running optimally. It is necessary to formulate a pattern of germs and antimicrobial resistance, not only in the intensive room, but also in the care ward to achieve ASP quality indicators.

Objectives: Antibiotic overuse is one of the main drivers of antimicrobial resistance (AMR), especially in low and middle-income countries. This study aimed to gain an understanding of perceptions, views, and practices regarding AMR, antibiotic prescribing, and stewardship (AMS) among hospital physicians in Jakarta, Indonesia. Design: cross-sectional, self-administered questionnaire-based survey, with descriptive statistics, exploratory factor analysis (EFA) to identify distinct underlying constructs in the dataset, and multivariable linear regression of factor scores to analyse physician subgroups. Setting: Six public and private general hospitals in Jakarta in 2019. Participants: 1007 of 1896 (53.1% response rate) antibiotic prescribing physicians. Results: EFA identified six latent factors (overall Crohnbach alpha=0.85): awareness of AMS activities; awareness of AMS purpose; views regarding rational antibiotic prescribing; confidence in antibiotic prescribing decisions; perception of AMR as a significant problem; and immediate actions to contain AMR. Physicians acknowledged the significance of AMR and contributing factors, rational antibiotic prescribing, and purpose and usefulness of AMS. However, this conflicted with reported suboptimal local hospital practices, such as room cleaning, hand hygiene and staff education, and views regarding antibiotic decision-making. These included insufficiently applying AMS principles and utilising microbiology, lack of confidence in prescribing decisions, and defensive prescribing due to pervasive diagnostic uncertainty, fear of patient deterioration or because patients insisted. Physicians factor scores differed across hospitals, departments, work experience and medical hierarchy. Conclusions: AMS implementation in Indonesian hospitals is challenged by institutional, contextual and diagnostic vulnerabilities, resulting in externalising AMR instead of recognising it as a local problem. Appropriate recognition of the contextual determinants of antibiotic prescribing decision-making will be critical to change physicians attitudes and develop context-specific AMS interventions