Knowledge, Attitudes, and Practices Regarding Antimicrobial Stewardship among Antimicrobial Prescribers at Five Acute Care Hospitals

Background: Previous studies suggest that 20-50% of antibiotics prescribed in U.S. hospitals are either unnecessary or inappropriate. We administered a knowledge, attitudes, and practices (KAP) survey to prescribers to assess barriers to optimal antimicrobial prescribing. 

Methods: An anonymous, web-based antimicrobial stewardship (AS) KAP survey was distributed at 5 acute care hospitals in the same hospital system. Eligible respondents included house staff, intensive care unit and emergency department physicians, hospitalists, physician assistants, and nurse practitioners. AS programs in the 5 hospitals primarily relied on antibiograms, institutional guidelines, and/or pre-prescription authorization; resources for post-prescription review and feedback (PPRF) were not available.

Results: 402 respondents completed the survey. Knowledge gaps were identified through case-based questions. Many (29%) selected overly-broad therapy for the susceptibilities given. Many prescribers (32%) “usually” or “always” preferred using the most broad-spectrum empiric antimicrobials possible. Nearly all (99%) reported reviewing antimicrobial appropriateness at 48-72 hours, but only 55% reported “always” doing so. PPRF was the most commonly cited (79%) AS intervention with potential to improve patient care. Only 55% agreed that they had received adequate training on antimicrobial use and prescribing. A notable proportion lacked confidence de-escalating therapy (18%), interpreting susceptibility results (24%), selecting empiric therapy using antibiograms (30%), and determining duration of therapy (31%). Computer-based training resources, lectures, and case-based discussions were the preferred education methods.

Conclusion: This survey of front-line prescribers in acute care hospitals identified several barriers to appropriate antimicrobial selection and de-escalation. Prescribers desired more AS-related education and identified PPRF as the most helpful AS intervention to improve patient care. Future research efforts will focus on the identification of changes in antimicrobial prescribing practices and clinical outcomes associated with enhanced AS educational initiatives and increased PPRF resources.