Knowledge, attitude, and practice of clinicians about antimicrobial stewardship and resistance among hospitals of Pakistan: a multicenter cross-sectional study

Abstract

Considering that antimicrobial resistance (AMR) is a global challenge, there is a dire need to assess the knowledge, attitude, and practice (KAP) of clinicians in AMR endemic countries. The current multicenter, cross-sectional study aimed at highlighting gaps in antimicrobial (AM) stewardship and AMR among practicing doctors working in public tertiary care teaching hospitals of Lahore, Pakistan. A KAP survey, based on a self-administered questionnaire containing 45 questions, was distributed among 336 clinicians in 6 randomly selected hospitals. Overall, 92% of the clinicians considered AMR as a worldwide problem but only 66% disagreed that cold and flu symptoms require antibiotics. Moreover, around 68% of the doctors felt confident about their practice in AM but still, 96% felt the need to get more knowledge about AM drugs. The need for refresher courses on rational antibiotic use was expressed by 84% of the participants. The main contributing factors considered for AMR by the doctors included excessive AM usage in the medical profession (87.1%) and multiple antibiotics per prescription (76.4%). Pharmacologically, AM spectrum was accurately chosen by 1.4% for Ampicillin, 0.003% for Erythromycin and 0% for Levofloxacin. Clinically, more than 50% of the clinicians used miscellaneous AM for empirical therapy of respiratory tract infection and cholecystitis. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. It is concluded that the knowledge of clinicians is relatively poor for AM spectrum and drugs of choice for certain infections. However, the clinicians are aware of their shortcomings and desire for improvement.

A Multicenter Cross-Sectional Survey of Knowledge, Attitude, and Practices of Healthcare Professionals towards Antimicrobial Stewardship in Ghana: Findings and Implications

“…Over 50% of the HCPs surveyed had at least a bachelor's degree as their highest level of education, with three-quarters of the practitioners having at least 10 years of working experience. Consequently, our study findings were not from newly employed staff nor those of lower educational background, which is similar to other studies [60,65]; however, at variance with others [57,59].…”

“…The calculated sample size for the number of HCPs (doctors, pharmacists, and nurses) using a margin of error of 5%, a 95% confidence level with a total population of 2798, a 50% assumed rate of appropriate KAP of ASP based on the findings from similar studies [49,61,65,74], and using the Raosoft online sample size calculator (http://www.raosoft.com/samplesize.html (accessed on 20 June 2023)) was 338. Using a 5% possible non-response rate, an upward adjustment of the sample size to 355 was made.…”

“…The KAP questionnaire was adapted from similar studies [49,61,65,74] and reviewed based on the considerable experience of the co-authors in this field. We have used a similar approach previously where no standard questionnaire existed [50,75,76].…”

Knowledge, attitude and practice of healthcare workers towards antibiotic resistance during the COVID-19 pandemic

“… 41 In Pakistan, clinician’s knowledge about ASP and AR was relatively poor. 42 In Najran, KSA, similar findings were also reported among HCWs regarding the COVID-19 pandemic. 43 In contrast, in Egypt, the mean (standard deviation) of physicians’ knowledge towards antibiotics was 8.65 (±1.69) out of 11.…”

Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review

“…However, four studies stated that prescribers had sufficient knowledge of the correct antibiotic indication (i.e. correct dose, diagnosis, and duration of antibiotic) [ 50 – 52 , 59 ]. In terms of attitude towards ASP implementation, the majority of prescribers showed positive attitudes, as they felt ASP is beneficial for both prescribers and patients [ 27 , 29 , 31 , 45 , 49 , 51 , 52 , 60 , 61 ], and were interested receive feedback on their antibiotic prescriptions [ 27 , 31 , 45 , 52 ].…”