Knowledge, attitude, and practice of clinicians regarding antimicrobial stewardship: a cross-sectional study in a tertiary hospital of East China

Antimicrobial resistance (AR) is an increasingly significant public health challenge worldwide owing to its negative impact on morbidity, mortality, and healthcare costs. Antimicrobial stewardship (AMS) is an important method for curbing AR. The knowledge-attitude-practice (KAP) model is a well-established theoretical framework applied to individual behavioral changes. There are some studies propose the challenges of AMS in low-and middle-income countries (LMICs). In December 2023, we conducted a cross-sectional survey among clinicians in a tertiary hospital of East China to assess their level of KAP toward AMS, using a validated electronic questionnaire. Of the 336 respondents, 329 were considered effective after screening, yielding a recovery rate of 97.9%. Clinicians scored higher in overall knowledge (43.6 ± 5.4) and attitude (44.3 ± 4.9), older and more experienced clinicians tended to have higher knowledge and attitude scores (P < 0.05). The content of antimicrobial surveillance, such as clinical use and bacterial drug resistance, had low scores. The overall practice score (41.8 ± 5.0) was low and the practice scores of clinicians in surgical departments and intensive care units were higher than those in other departments (P < 0.05). Clinicians resort to irrational antibiotic use because of concerns regarding adverse events. The correlation analysis of KAP with AMS revealed that knowledge, attitude, and practice were all related (P < 0.05). Our study identified the key populations and priorities for AMS education and training. Urgent measures are needed to improve clinicians' practices in AMS and mitigate irrational antibiotic use. In order to strengthen the AMS, improving knowledge itself is not enough, both hospitals and national governments need to provide corresponding support and guarantees.