Antimicrobial Stewardship Knowledge Research Articles

The Impact of Antimicrobial Stewardship Training on Calf Producers' Knowledge, Treatment Behaviors and Quantified Antimicrobial Use.

The judicious use of antimicrobials on farms is necessary to mitigate the development of antimicrobial-resistant pathogens that compromise human and animal health. On livestock farms, veterinarians prescribe and dispense antimicrobials, but producers use rapid judgements of disease severity to make routine decisions on the initiation of empirical antimicrobial therapy. Therefore, the knowledge and skills required to accurately diagnose treatable bacterial infections is necessary for optimal antimicrobial stewardship. Veal calves often undergo stressors and environmental exposures that increase calves’ risk of bacterial infections, and antimicrobials are sometimes necessary to ensure their health. The objective of this trial was to measure the impact of antimicrobial stewardship training on calf producers’ knowledge of antimicrobial stewardship, accuracy of identifying calves for treatment, and quantified antimicrobial use. Eight farms were evenly allocated into either intervention or control groups. Training resulted in both higher scores on assessments and higher sensitivity for detecting cases that required antimicrobial therapy relative to a veterinarian. Importantly, there was a 50% reduction in the antimicrobial dosing rate among intervention farms relative to control farms. Antimicrobial stewardship training among calf producers was effective at changing producers’ behaviors and reducing antimicrobial use.

Private practice dentists improve antibiotic use after dental antibiotic stewardship from infectious diseases experts

Background: Dentists prescribe ~25.7 million antibiotic prescriptions annually. Private practice dentists (PPDs) represent 80% of US dentists who need to implement dental antimicrobial stewardship. We conducted a prospective cohort study of PPDs comparing appropriateness of antibiotic use before and after dental AS education. Methods: PPDs were invited to participate in this study. In phase 1 (pre-education), we collected 3 months (June–August 2019) of retrospective antibiotic use data (indication, dose, duration, penicillin allergy history) and number of dental procedures. We also conducted a preliminary survey to assess baseline antimicrobial stewardship knowledge. In phase 2 (education), PPDs attended 4 televideo education sessions (March–May 2021) taught by an infectious disease– antimicrobial stewardship (ID-AS) pharmacist and physician. In phase 3 (posteducation), we prospectively collected 3 months (June–August 2021) of antibiotic use data (as in phase 1), using an online database with ongoing feedback. In phase 4, we conducted antibiotic use audit and feedback to PPDs after the survey, and we solicited recommendations to reach more PPDs. The Student t test was used for statistical analyses. Results: Study participants comprised 15 PPDs: 2 oral maxillofacial surgeons, 6 periodontists, 4 endodontists, and 3 general dentists. Among them, 10 had been in practice >20 years. The presurvey revealed that 14 were unfamiliar with dental antimicrobial stewardship. All prescribed clindamycin (25% for nonpenicillin allergy), and standard antibiotic duration ranged from 5 to 14 days based on dental school training. In phase 3, despite more procedures, overall antibiotic use and duration decreased, and the use of clindamycin, quinolones, and prophylaxis for joint implant patients, also decreased. Appropriate use improved from 22% to 95%. Postsurvey responses on perceived value of antimicrobial stewardship education were 100% positive, with recommendations to make antimicrobial stewardship a required annual continuing education, similar to opioid continuing education. Study participants invited the ID-AS experts to teach an additional 150 PPDs to date via established PPD study clubs to expand dental antimicrobial stewardship across the United States. Conclusions: After learning dental antimicrobial stewardship guidance from ID-AS experts, PPDs rapidly optimized antibiotic prescribing behavior. PPDs identified their established study clubs as a forum to quickly expand dental antimicrobial stewardship training by ID-AS experts throughout the United States.Funding: MERCKDisclosures: None

Coaching ward pharmacists in antimicrobial stewardship: A pilot study

BackgroundWard pharmacists are well-positioned to enhance the activities of hospital antimicrobial stewardship (AMS) programs by reviewing the appropriateness of antimicrobials and making recommendations to prescribers. However, recent studies have identified gaps in ward pharmacists' AMS practice, knowledge, skills, and confidence which suggests education and training programs are needed. Objective(s)To describe, for the first time, an interactive educational activity – coaching in AMS – targeted at ward pharmacists and explore their perceptions of coaching as a mode of delivering education to improve AMS knowledge, skills, confidence, and practice. A secondary objective was to describe the type, frequency, and acceptance of AMS recommendations made by coached pharmacists. MethodsThis was a descriptive pilot study with a qualitative evaluation of pharmacists' perceptions and experiences of coaching. AMS coaching was delivered over 2 months in 2019 to pharmacists providing clinical pharmacy services to general medical and surgical wards. A focus group was conducted one month after the coaching period to elicit pharmacists' perceptions of coaching as a mode of delivering AMS education and how it impacted their AMS knowledge, skills, confidence, and practice. AMS recommendations made by coached pharmacists were prospectively recorded, and the prescriber acceptance rate was determined. ResultsWard pharmacists reported positive experiences with AMS coaching and believed it helped them identify a range of recommendations to improve antimicrobial prescribing and increased their confidence to communicate recommendations to prescribers. Workload issues were identified as the main barrier to implementation. Suggestions were provided to improve coaching implementation feasibility. During coaching, 162 AMS recommendations were identified for a range of antimicrobials, and 69% (113/162) were accepted and implemented. ConclusionsWard pharmacists believed coaching improved their AMS knowledge, skills, confidence, and practice, including their confidence to discuss recommendations with prescribers. These results can assist with the design and evaluation of future hospital-based AMS educational initiatives.

Evaluation of knowledge, awareness, and practice of antimicrobial stewardship among prescribers of a teaching hospital in South India

Background: The injudicious and indiscriminate use of antimicrobials has led to the development of antimicrobial resistance (AMR), particularly in the low- and middle-income countries. Antimicrobial Stewardship (AMS) is the coordinated intervention to enhance the appropriate use of antimicrobials. Antimicrobial stewardship program (ASP) is a multidisciplinary program with interventions and strategies to encourage AMS to prevent emergence of AMR. Aims and Objectives: This study aimed at evaluating the knowledge, awareness, and practice (KAP) of AMS among prescribers of a teaching hospital in South India. Materials and Methods: A cross-sectional questionnaire based study conducted after obtaining Institutional Ethics Committee approval was conducted among prescribers of a teaching hospital from September 2022 to October 2022. Responses to the questionnaires issued to the prescribers through Google Forms were analyzed by descriptive statistics using Microsoft excel. Results: A total of 230 prescribers submitted the filled in questionnaires. The definition of AMS was known to 62%. The constitution and functioning of ASP was known to 59%. However, only a few (38%) prescribers agreed that antimicrobials are avoided in viral infections. More than 60% had good awareness of AMS. However, only 25% were aware of an ASP program is their hospital. Fifty percent agreed to the practice of reviewing antimicrobial use after 48–72 h and only 38% to the practice of obtaining cultures before prescribing antimicrobials. Conclusions: The prescribers had moderate knowledge and awareness and poor practice of AMS. To address these gaps, educational interventions and capacity building approaches are required.

Knowledge and perceptions of antimicrobial resistance and antimicrobial stewardship among staff at a national cancer referral center in Uganda.

As access to cancer care has improved throughout sub-Saharan Africa, treatment-associated infections have increased. Assessing healthcare worker knowledge of antimicrobial stewardship and identifying the barriers to infection management will inform the development of contextually appropriate antimicrobial stewardship programs, improving cancer outcomes in sub-Saharan Africa. Cross-sectional survey. The Uganda Cancer Institute (UCI), a national cancer referral center in Kampala, Uganda. We surveyed 61 UCI staff: 29 nurses, 7 pharmacists, and 25 physicians. The survey contained 25 questions and 1 ranking exercise. We examined differences in responses by staff role. All 60 respondents who answered the question had heard the term "antimicrobial resistance." Only 44 (73%) had heard the term "antimicrobial stewardship." Nurses were less likely than pharmacists or physicians to be familiar with either term. Also, 41 respondents (68%) felt that loss of antibiotic susceptibility is a major issue at UCI. Regarding barriers to diagnosing infections, 54 (93%) of 58 thought that it was difficult to obtain blood cultures and 48 (86%) of 56 thought that it was difficult to regularly measure temperatures. Although most recognized the term "antimicrobial resistance," fewer were familiar with the term "antimicrobial stewardship." Inappropriate antibiotic use was recognized as a contributor to antimicrobial resistance, but hand hygiene was underrecognized as a contributing factor. We identified numerous barriers to diagnosing infections, including the ability to obtain blood cultures and consistently monitor temperatures. Educating staff regarding antimicrobial selection, allocating resources for blood cultures, and implementing strategies to enhance fever detection will improve infection management.

Knowledge, Awareness and Practice with Antimicrobial Stewardship Programmes among Healthcare Providers in a Ghanaian Tertiary Hospital.

Antimicrobial resistance (AMR) is a significant problem in global health today, particularly in low- and middle-income countries (LMICs) where antimicrobial stewardship programmes are yet to be successfully implemented. We established a partnership between AMR pharmacists from a UK NHS hospital and in Ho Teaching Hospital with the aim of enhancing antimicrobial stewardship knowledge and practice among healthcare providers through an educational intervention. We employed a mixed-method approach that included an initial survey on knowledge and awareness before and after training, followed by qualitative interviews with healthcare providers conducted six months after delivery of training. This study was carried out in two phases in Ho Teaching Hospital with healthcare professionals, including pharmacists, medical doctors, nurses and medical laboratory scientists. Ethical approval was obtained prior to data collection. In the first phase, we surveyed 50 healthcare providers, including nurses (33%), pharmacists (29%) and biomedical scientists (23%). Of these, 58% of participants had engaged in continuous professional development on AMR/AMS, and above 95% demonstrated good knowledge on the general use of antibiotics. A total of 18 participants, which included four medical doctors, five pharmacists, four nurses, two midwives and three biomedical scientists, were interviewed in the second phase and demonstrated greater awareness of AMS practices, particularly the role of education for patients, as well as healthcare professionals. We found that knowledge and practice with AMS was markedly improved six months after the training session. There is limited practice of AMS in LMICs; however, through AMR-focused training, we demonstrated improved AMS skills and practice among healthcare providers in Ho Teaching Hospital. There is a need for continuous AMR training sessions for healthcare professionals in resource-limited settings.

136. Attitudes and Practices of Antimicrobial Resistance and Antimicrobial Stewardship at the Uganda Cancer Institute

BackgroundAs access to cancer treatment has increased in sub-Saharan Africa (sSA), infection-related complications are a growing concern. Little is known about infection management practices in this setting. Understanding the unique challenges to diagnosing and treating infections can inform the development of targeted strategies to improve infection management for cancer treatment programs throughout sSA. MethodsWe conducted a cross-sectional survey of doctors, nurses, and pharmacists at the Uganda Cancer Institute (UCI), a national cancer referral hospital in Kampala, Uganda. The 25-item survey was designed to assess staff knowledge of antimicrobial resistance and antimicrobial stewardship, investigate antibiotic decision-making practices, and identify barriers to diagnosing and treating infections. ResultsOf the 61 respondents, 25 (41%) were doctors, 7 (11%) were pharmacists, and 29 (48%) were nurses. In total, 98% (60/61) had heard of the term “antimicrobial resistance” and 84% (51/61) agreed that antimicrobial resistance is an important problem at UCI. Multiple factors were felt to contribute to antimicrobial resistance including the use of too many antibiotics, patient insistence on antibiotics, and poor patient adherence (Fig 1). While 72% (44/61) had heard of the term “antimicrobial stewardship”, only 25% (15/61) knew a lot about what it meant. Numerous factors were considered important to antibiotic decision-making including patient white blood cell count and severity of illness (Fig 2). Perceived barriers to infection diagnosis included the inability to obtain blood cultures and to regularly measure patient temperatures; perceived barriers to obtaining blood cultures included patient cost and availability of supplies (Fig 3). Figure 1. Factors that doctors, pharmacists, and nurses working at the Uganda Cancer Institute (UCI) perceive as contributing to antimicrobial resistance at the UCI. Percentages shown next to bars represent the combined total percentage of respondents reporting that the factor does not or usually does not contribute (left of bars, main chart), occasionally or frequently contributes (right of bars, main chart), or neither contributes nor does not contribute (right of neutral chart).Figure 2. Factors that doctors, pharmacists, and nurses working at the Uganda Cancer Institute consider to be important when choosing antibiotics to treat infections. Percentages shown next to bars represent the combined total percentage of respondents reporting that the factor is somewhat or very unimportant (left of bars, main chart), somewhat or very important (right of bars, main chart), or neither important nor unimportant (right of neutral chart).Figure 3. Factors that doctors, pharmacists, and nurses working at the Uganda Cancer Institute perceive as limiting the ability to diagnose infections and obtain blood cultures. ConclusionWhile most staff recognized the term “antimicrobial resistance” and identified this as a major local problem, fewer were familiar with the term “antimicrobial stewardship”. We identified numerous perceived barriers to infection diagnosis and treatment, including the ability to consistently measure temperatures and the cost of blood cultures. A multipronged approach is needed to improve staff knowledge of antimicrobial stewardship and to address the systematic barriers to infection management at UCI. Disclosures All Authors: No reported disclosures

958. A Required Infectious Diseases Rotation Improves Antimicrobial Stewardship Knowledge for Internal Medicine Interns

BackgroundExposure to Infectious Diseases (ID) education is highly variable in post-graduate medical training. We report our experience with a required one-week ID consult rotation for Internal Medicine (IM) interns with a focus on antimicrobial stewardship education.MethodsSince 2018 all IM interns at our institution have participated in a required one-week ID consult rotation. Antimicrobial stewardship is a core feature of this rotation, with educational resources on antibiotic spectrum and decision-making, and interdisciplinary rounding with ID pharmacists. Between March 2020 and May 2021 we piloted an 11-item pre-rotation and post-rotation quiz with distinct but paired questions on key stewardship topics. The quiz was administered anonymously in SurveyMonkey. Mean pre/post rotation scores were compared using a paired T-test and the McNemar test of paired proportions was used to compare the pre/post change in percentage of correct responses for each topic.ResultsAmong 47 interns who completed the rotation, 16 interns completed both pre- and post-rotation quizzes (response rate=34%). Mean scores on the pre-rotation quiz were 60%, compared to 77% on the post-rotation quiz (p=0.01), indicating significant improvement at the end of the rotation (Figure 1). Among 11 residents who scored below 65% on their pre-rotation quiz, all achieved an increased score on their post-rotation quiz (mean pre-test of 49% to mean post-test 79%). Table 1 displays the question topics and pre/post test change in percentage correct. The most difficult pre-test topics were ‘Recognition of AmpC-Expressing Organisms’ and ‘Antibiotics with activity against Pseudomonas aeruginosa,’ which improved, from 31% to 81% correct (p=0.03) and 50% to 100% correct (p=0.01), respectively. Figure 1. Mean score of interns on pre-rotation vs post-rotation antimicrobial stewardship quiz from March 2020 to May 2021 (n=16; p=0.01).Table 1. Question topics and change in percentage correct on pre-rotation and post-rotation quizzes. ConclusionA required one-week ID consult rotation for IM interns improved antimicrobial stewardship knowledge. Our experience may serve as a model for other institutions interested in increasing IM housestaff exposure to ID and antimicrobial stewardship.Disclosures Kristen Marks, MD, Gilead Sciences (Grant/Research Support)

Delivery of antimicrobial stewardship competencies in UK pre-registration nurse education programmes: a national cross-sectional survey

Registered nurses perform numerous functions critical to the success of antimicrobial stewardship, but only 63% of pre-registration nursing programmes include any teaching about stewardship. Updated nursing standards indicate that nurses require antimicrobial stewardship knowledge and skills. To explore the delivery of key antimicrobial stewardship competencies within updated pre-registration nursing programmes. This study had a cross-sectional survey design. Data were collected between March and June 2021. Lecturers from 35 UK universities responsible for teaching antimicrobial stewardship participated in this study. The provision of antimicrobial stewardship teaching and learning was inconsistent across programmes, with competencies in infection prevention and control, patient-centred care and interprofessional collaborative practice taking precedent over competencies pertaining to the use, management and monitoring of antimicrobials. Online learning and teaching surrounding hand hygiene, personal protective equipment and immunization theory was reported to have increased during the pandemic. Only a small number of respondents reported that students shared taught learning with other healthcare professional groups. There is a need to ensure consistency in antimicrobial stewardship across programmes, and greater knowledge pertaining to the use, management and monitoring of antimicrobials should be included. Programmes need to adopt teaching strategies and methods that allow nurses to develop interprofessional skills in order to practice collaboratively.

Impact of an interactive, clinical decision-making workshop on student learning of antimicrobial stewardship principles

Background and purposeEducational escape room activities are being implemented in various classroom environments to augment learning. These games are structured in a linear pathway, and all participants must complete riddles to arrive at the same answer and “escape the room.” Educational activity and settingInvestigators created a multi-directional interactive learning activity where students were presented with a patient case. The activity required students to identify the presented infectious disease, interpret microbiology results, and select antibiotic treatment options. Students were required to provide dosing and antimicrobial stewardship metrics based on their treatment selection along with rationale. Upon completion of the activity, students participated in group discussions explaining the reasoning behind their selected treatment option. They also completed a satisfaction survey. Knowledge of antimicrobial stewardship principles was assessed via a multiple-choice exam. Exam performance was compared to the prior year when a traditional lecture format was utilized to teach the topic. FindingsOf 194 students enrolled in the course, 138 completed the satisfaction survey. The majority (86.9%) indicated that they would recommend the activity and 88.2% considered it an effective tool for learning antimicrobial stewardship. There was a mean decline of 6.38% (P = .3) in correctly answered exam questions with the implementation of the activity compared to results from the previous academic year (N = 185). SummaryStudents perceived the game as a valuable learning experience, but it did not result in an improvement in knowledge of antimicrobial stewardship as assessed by multiple-choice exams.

Knowledge and self-reported confidence in antimicrobial stewardship programme among final year pharmacy undergraduate students in Malaysia and Nigeria

Objective: This study evaluated the knowledge and self-reported confidence of antimicrobial stewardship (AMS) among pharmacy students in Malaysia and Nigeria. Methods: A cross-sectional study was conducted among final year undergraduate pharmacy students in a university from both Nigeria and Malaysia using a 59-item online questionnaire. Results: A total of 150 final year undergraduate pharmacy students completed the questionnaire. Exposure to infectious diseases clerkship was higher among the Malaysian students (78.2% versus 25.4%; p < 0.001). Overall, the knowledge score for antibiotic resistance and AMS were comparable (6.2 ± 1.5 and 3.6 ± 1.2, respectively versus 5.9 ± 1.6 and 3.3 ± 1.3). The knowledge of antibiotic therapy was higher among the Malaysian students (5.4 ± 1.8 versus 4.2 ± 1.8; p < 0.001) while self-reported confidence to participate in AMS was higher among the Nigerian students (median 48.0, IQR 26 – 75 versus median 36.5, IQR 15 – 75; p < 0.001). Conclusions: Pharmacy students in Malaysia and Nigeria have appreciable knowledge of antibiotic resistance, antibiotic therapy and AMS. More training on topics is recommended to improve the skills and competency of future pharmacists to participate in AMS.

Assessing Knowledge and Perception Regarding Antimicrobial Stewardship and Antimicrobial Resistance in University Students of Pakistan: Findings and Implications.

The irrational use of antimicrobials has enormously contributed to antimicrobial resistance (AMR) globally and especially in the developing world. To assess the knowledge and perception regarding AMR and antimicrobial stewardship (AMS), a descriptive cross-sectional study was carried out in university students enrolled in pharmacy, veterinary, and biology programs by using an online self-administered questionnaire. The Chi-square and Fisher exact tests (where applicable) were performed to assess the association of the demographics with the students’ knowledge and perception regarding AMR and AMS. A total of 496 students completed the questionnaire, among which, 85.7% of the participants were familiar with the term AMR and 79.4% of the participants correctly identified a poorly designed dosing regimen as a contributing factor towards AMR. The majority of participants (57.9%) were familiar with the term AMS and 86.5% were aware of the aim of AMS. The participants showed good knowledge regarding AMR and AMS, but to further improve student knowledge and perception of AMS and AMR, it is suggested that dedicated modules on antibiotic use and AMS should be incorporated into the curricula of these undergraduate and postgraduate programs.

Antibiotic stewardship knowledge and belief differences among healthcare professionals in hospitals: A survey study

BackgroundCollaborative practice in healthcare has been recommended to improve the quality of antimicrobial stewardship interventions, a behavioral change in antimicrobial use. Insufficient knowledge regarding antibiotic resistance, the fear of complications from infections, and how providers perceive antibiotic use and resistance are likely to influence prescribing behavior. This study's objective was to identify the knowledge and belief healthcare professionals' differences about antibiotic stewardship. MethodsThis cross-sectional survey study of three hospitals in the East Java province, Indonesia utilized a 43-item questionnaire to assess antimicrobial stewardship knowledge and belief. There were 12 knowledge questions (total possible score: 12) and 31 belief questions (total possible score: 155). The Kuder Richardson 20 (KR-20) and Cronbach alpha values of the questionnaire were 0.54 and 0.92, respectively. ResultsOut of the 257 respondents, 19% (48/257) had a low scores of knowledge, and 39% (101/257) had low scores on belief about antibiotic stewardship (101/257). Most midwives had a low scores on knowledge (25/61) and low scores on belief (46/61). Respondents with high scores on belief were 17% (10/59) physicians, 15% (4/27) pharmacists, 8% (5/65) nurses, and 3% (2/61) midwives. ConclusionAmong healthcare professionals, knowledge and belief differences concerning antibiotic stewardship vary widely. These differences will affect their capability, behavior, and contribution to the healthcare team collaboration and performance. Further studies are needed to evaluate the correlation between the level of inter-professional collaboration and the quality of the antibiotic stewardship implementation.

Feasibility of implementing antimicrobial stewardship programs in acute-care hospitals: A nationwide survey in Thailand.

A nationwide survey was conducted in 399 acute-care hospitals in Thailand. Most had a designated antimicrobial stewardship program (ASP), but <20% had an infectious disease physician on the team. The most frequently cited challenges in ASP implementation were the increased workload, followed by a lack of antimicrobial stewardship knowledge and a lack of hospital administrator concern.

Antimicrobial Stewardship Programs in Northwest China: A Cross-Sectional Survey of Perceptions, Involvement, and Perceived Barriers Among Hospital Pharmacists.

Background: Antimicrobial stewardship (AMS) is a key prevention strategy in addressing the global concern of increasing antimicrobial resistance (AMR). Pharmacists are one of the integral members of AMS hospital teams around the world. Toward reducing AMR, a major strategy in China is to improve the capacity and participation of pharmacists in the AMS framework. However, little is known about how hospital pharmacists perceive their position and participation in AMS work, and the barriers to this work in China, especially in the Northwest region. Methods: Region this work describes a cross-sectional, anonymous, online survey study. Hospital pharmacists from five provinces/autonomous regions in northwest China were invited to participate in June and July 2020. Participants completed the survey by using WeChat, a popular social application in China. We purposefully distributed the questionnaire link and QR code to hospital pharmacists through the hospital antimicrobial resistance surveillance network, hospital antimicrobial consumption surveillance network, provincial and city pharmaceutical associations, and hospital pharmacist WeChat groups. Results: Out of 1032 respondents, 93.1% believed that AMS programs promote the judicial prescribing of antimicrobials, 95.5% strongly agreed that AMS could reduce the widespread use of antimicrobials, and 92.3% believed that AMS could improve medical services. Pharmacists were most likely to be involved in AMS through reviewing prescriptions of antimicrobials, intervening in inappropriate prescriptions, and providing feedback on antimicrobial prescriptions and medical orders. Barriers to participating in AMS included workload (59.5% of respondents), ineffective communication between pharmacists and doctors (57.7%), and inadequate knowledge of AMS (47.0%). Differences in responses were found between the five surveyed provinces. A significant association was found between median involvement scores and gender, age, education, level of superiority, experience, and type of hospital (p < 0.05). Conclusion: Pharmacists perceived that AMS programs are important, but that their involvement in related activities is limited in all provinces. Further studies and strategies should consider how to overcome the identified barriers to optimize the participation of pharmacists in AMS programs.

Knowledge, Attitude and Practices of Clinicians, Nurses and Pharmacists Regarding Antimicrobial Stewardship: A Five Centre Survey from India

Introduction: Increasing awareness and practice of Antimicrobial Stewardship (AMS) has gained immense importance in Indian hospitals for preventing the irrational use of antibiotics. India is one of the world’s largest consumers for antibiotics. Assessment of the local Knowledge, Attitude and Practices (KAP) of Antimicrobial Resistance (AMR) and AMS among Healthcare Providers (HCPs) will help in designing effective public health policies and engaging the community in campaigns against increasing microbial resistance. Aim: To understand the status of AMS programs and practices in five private sector multispecialty hospitals situated in the East, West, North and South zones of the country and to assess the KAP of HCPs regarding AMR and AMS. Materials and Methods: The cross-sectional survey was conducted to assess the implementation of AMS in five hospitals among clinicians, nurses and pharmacists across India using a predeveloped AMS checklist between June 2019 and October 2019. The analysis was done between July and August 2020. Responses were collected using a five-point Likert scale, with choices ranging from ‘strongly agree’ to ‘strongly disagree’.Descriptive analysis was done for the KAP survey to determine the percentages of participants under each response category. Results: Total 32 clinicians, 55 nurses and eight pharmacists responded to the KAP survey (100% response rate). The clinicians were aware that AMR is caused by irrational prescribing of antimicrobials (n=31, 96.87%) and improper diagnosis of infective conditions (n=27, 84.37%). However, knowledge of clinicians on infection control practices (n=6, 18.75% disagreed) in controlling AMR and practice of referring local epidemiology before prescribing antimicrobials (n=7, 21.87% did not follow routinely) could be improved. The knowledge and practice of nurses and pharmacists on antibiotic use were spread over a wide range. According to the nurses, AMR was mainly caused by using antimicrobials for non bacterial infections (n=30, 54.54%) and deviations from their standard duration (~63.64%-72.73%). As per pharmacists, the lack of restrictions on antimicrobial usage and widespread use or overuse of antibiotics were major contributors to AMR (n=3, 37.5% strongly agreed). Both nurses and pharmacists could benefit from reinforced training on antibiotic usage. Conclusion: Implementation of AMS was not adequate in private Indian hospitals. Although clinicians have good knowledge on antibiotic use, it was not equally reflected in their practice. The KAP data of nurses and pharmacists suggest that training and education on appropriate antibiotic usage should be emphasised. More efforts are required to improve AMS practices in hospitals.

Knowledge, Attitudes, and Perceptions Associated With Antimicrobial Stewardship Among Veterinary Students: A Multi-Country Survey From Nigeria, South Africa, and Sudan.

In African countries, antimicrobial resistance (AMR) issue remains pertinent. Despite this, little efforts have been made to assess the future veterinary prescribers on their knowledge, attitudes and practices (KAP) related to antimicrobial usage. This multi-country survey attempts to explore the KAP of future veterinarians on stewardship of antimicrobial and identify knowledge gaps. Eight veterinary schools participated from Nigeria, Sudan and South Africa. Data regarding perceptions and knowledge were analyzed using Chi-square χ2 test, Spearman's (Rho) Rank order correlation and factor analysis using principal component factoring extraction method. Fifty-two percent of the study participants were final year veterinary students, respectively, and majority (77.2%) had no previous knowledge of biomedical sciences. Majority age were 22–27 years (24.7 ± 2.8) 79% and multiple career fields post-graduation were preferred. Overall, poor perceptions and knowledge of antimicrobial stewardship were observed with variations among countries and only 36.3% (n = 123) of the students were confident in their ability to choose the ideal antimicrobial agents for a specific patient/group of animals. The majority of the final year students were confident of their knowledge regarding AMR (68%), making of Gram staining (69.2%) and in choosing the most ideal route for administering a specific antimicrobial (74.7%). The final year students had significantly (p < 0.05) higher confidence level for knowledge compared with the pre-final year students. Tetracyclines, penicillins, and sulphonamides represent the three most abused veterinary antimicrobials with similar ranking across countries. South African (69.7 ± 20.5) and Sudanese (68.1 ± 15.4) had significantly (p < 0.0001) higher mean scores compared to the Nigerian students (44.3 ± 6.8) in the student's ability to correctly match some specific antimicrobials against their classes but Nigerian students performed better in ranking antimicrobials. This survey revealed poor to average knowledge of antimicrobial stewardship among veterinary students with significant knowledge gaps across the countries. It is recommended that the relevant regulatory and standardization authorities should make concerted efforts and interventions to regularly review curricula to ensure the delivery of targeted formative and normative training, and improved lectures on antimicrobial usage and stewardship in order to improve the awareness and behaviors of future prescribers. The identified knowledge gaps of veterinary medical students on antimicrobial stewardship must be bridge to safeguard the future.

Antimicrobial-stewardship Knowledge, attitude, and practice among professional physicians in Saudi hospitals

Antimicrobial stewardship (AMS) is of vital significance to tackle the antibiotic resistance. Insights of physicians is important for implementation of AMS. Therefore, present study was conducted to assess the knowledge, attitude and practices regarding antibiotic stewardship among professional physicians in Riyadh, Saudi Arabia. A cross-sectional questionnaire-based survey was conducted among professional physicians between January 2020 to April 2020 in clusters of Saudi hospitals. The self-administered and closed ended questionnaire encompassed of informed consent, demographics information and questionnaire which included 7 items for knowledge, 10 for attitude and 8 for practices. Chi-square test and Fisher’s exact test was performed to assess the relationship of knowledge, attitude and practices with gender and medical specialty of the study participants along with descriptive statistics. A p value below (p&amp;lt;0.05) was considered significant for all the statistical purposes. A total of 413 medical practitioners participated in this study. Most of the participants were male 280 (67.8%), aged 31-40 years 163(39.4%). The term antimicrobial stewardship was known to 55.9% of participants and 65% of participants knew the difference between and bactericidal antimicrobial agents (). 71.9% participants opined that can be prevented by using specific . 89% of participants do not prescribe on demand of patients. Health professionals should be adequately trained regarding usage of and their consequences to curb the menace of quickly developing AMA resistance.

A cross-sectional survey of knowledge, perceptions and practice of antimicrobial stewardship concepts among university non-health professional undergraduate students in southwest Nigeria

Background: Non-health professional students (NHPS) can be a veritable tool in the advocacy for antimicrobial stewardship in a community if imbued with adequate knowledge and correct perceptions. However, little is known about the knowledge, perceptions, and practice (KPP) of antimicrobial stewardship among NHPS.Objective: This study aimed to evaluate the KPP of antimicrobial stewardship among NHPS.Methods: A cross-sectional survey of KPP of antimicrobial stewardship was carried out among 600 consecutively selected NHPS at Olabisi Onabanjo University, Nigeria, using a pretested 30-item self-administered questionnaire with varying options and a 5-point Likert scale. Each correct answer in the knowledge domain was scored “1” and incorrect “0” and a total of eleven points were available. The modified Bloom’s cut-off points were used to grade the knowledge into good (≥9 points), moderate (7-8 points) and poor (≤6 points). The Kruskal-Wallis test was used to assess the differences in perceptions among the groups.Results: Many of the respondents (319;53.2%) were male, 274 (45.7%) had used antimicrobials without advice from physicians or pharmacists. The respondents (387; 64.5%) scored ≤ 6.0 of the total 11.0 on the knowledge scale and 430 (71.7%) with a significant difference between faculties (p<0.001) strongly agreed or agreed that “everyone needs to take responsibility for using antimicrobials responsibly”.Conclusions: Many of the non-health professional students had poor knowledge of antimicrobial stewardship and had practices that are antithetical to the concept. However, the majority perceived correctly, that appropriate use of antimicrobials was a collective responsibility.Keywords: Antimicrobial; stewardship; non-health professional; knowledge; Nigeria

Knowledge, Perceptions and Practices of Community Pharmacists Towards Antimicrobial Stewardship: A Systematic Scoping Review.

The scope of antimicrobial stewardship (AMS) surveys on community pharmacists (CPs) is uncertain. This study examines the breadth and quality of AMS survey tools measuring the stewardship knowledge, perceptions and practices (KPP) of CPs and analyse survey outcomes. Following PRISMA-ScR checklist and Arksey and O’Malley’s methodological framework seven medical databases were searched. Two reviewers independently screened the literatures, assessed quality of surveys and KPP outcomes were analysed and described. Ten surveys were identified that assessed CPs’ AMS perceptions (n = 7) and practices (n = 8) but none that assessed AMS knowledge. Three survey tools had been formally validated. Most CPs perceived that AMS improved patient care (median 86.0%, IQR, 83.3–93.5%, n = 6), and reduced inappropriate antibiotic use (84.0%, IQR, 83–85%, n = 2). CPs collaborated with prescribers for infection control (54.7%, IQR 34.8–63.2%, n = 4) and for uncertain antibiotic treatment (77.0%, IQR 55.2–77.8%, n = 5). CPs educated patients (53.0%, IQR, 43.2–67.4%, n = 5) and screened guideline-compliance of antimicrobial prescriptions (47.5%, IQR, 25.2–58.3%, n = 3). Guidelines, training, interactions with prescribers, and reimbursement models were major barriers to CP-led AMS implementation. A limited number of validated survey tools are available to assess AMS perceptions and practices of CPs. AMS survey tools require further development to assess stewardship knowledge, stewardship targets, and implementation by CPs.