Emergency Department Physicians' Knowledge, Attitudes, and Behaviors Regarding Antimicrobial Use, Resistance, and Stewardship: A Cross-Sectional Study

Objective: Antimicrobial resistance (AMR) is a global public health threat. In our country, emergency departments, where antibiotics are most frequently prescribed, have limited data regarding physicians' knowledge, attitudes, and behaviors related to antibiotic use (AMU), AMR, and antibiotic stewardship (AMS). Methods: A cross-sectional survey was conducted among emergency department (ED) physicians in a major city in western Turkey. The online survey assessed their knowledge, attitudes, and behaviors regarding AMU, AMR, and AMS. The internal consistency of the questionnaire was validated with a Cronbach’s alpha of 0.77. Results: Among the 141 participating physicians, 54.6% were assistants, 34.0% specialists, 7.09% faculty members, and 4.26% general practitioners. The median knowledge score was 90.0 [Q1; Q3: 80.0; 100], and 69.5% had good knowledge, but a lack of knowledge about antimicrobial agents' (AMA) pharmacology was observed. The median attitude score was 59.4 [Q1; Q3: 56.2; 68.8], and 48.2% had correct attitudes. Wrong attitudes were observed in the AMA administration. The median behavior score was 53.0 ± 16.6, with 53.9% of physicians exhibiting appropriate behavior regarding the use of AMA. The most important factors affecting behavior were patient insistence and errors in empirical AMA administration. A positive correlation was observed between attitudes and behaviors (r = 0.397, p