Knowledge, Attitudes and Practices of Physicians Regarding Antifungal Therapy in Tertiary Care Patients: A Cross-Sectional Survey in Greece

The rising incidence of invasive fungal infections (IFIs) and the associated antifungal resistance underscore the need for antifungal stewardship (AFS) programs. Evaluating physicians' knowledge and practices is crucial for identifying gaps and planning effective AFS interventions. A self-administered questionnaire was distributed to staff and resident physicians at a referral university-affiliated hospital in Greece in November 2025. The survey examined participants' knowledge on fungal diagnosis and treatment, their prescribing attitudes and practices, and their AFS-related education, knowledge and preferences. In total, 70 physicians (46 residents and 24 staff consultants) participated in the survey from medical departments (63%), surgical departments (30%), and intensive care units (7%). Physicians surveyed demonstrated a low average knowledge score of 36.6% correct answers (SD, 22.7%; range 0% to 90%) regarding IFIs and antifungal agents, and significant variation was observed across different hospital departments. Awareness of risk factors for IFI varied widely, with recognition rates of different factors ranging from 10% to 100% across departments. Many physicians (71%) reported a lack of confidence in prescribing antifungal therapy and reliance on infectious disease experts was common (84%). Most preferred training methods were case-based discussions and printed guidelines. The substantial knowledge gaps and low confidence in prescribing antifungals among physicians highlight the urgent need for education and implementation of local guidelines to optimize antifungal use that might improve patient outcomes.