Assessing Healthcare Worker Knowledge, Attitudes, and Practices Regarding Antimicrobial Stewardship and Antimicrobial Resistance Patterns in a Tertiary Care Hospital

Abstract

Background: Antimicrobial resistance (AMR) is a serious threat to public health worldwide, and if left unchecked, is estimated to kill more people per year than cancer. One of the key responses is antimicrobial stewardship (AMS) programmes, which can only be effective if healthcare workers who prescribe and use antimicrobials know, think and do the right things. There are opportunities for interventions in antimicrobial stewardship in tertiary care hospitals, which have high antimicrobial use and a higher proportion of patients that are critically ill, thereby driving selection of resistance.
Objective: The objective of this study was to evaluate the knowledge, attitude, practices and trends of antimicrobial resistance among healthcare workers and to analyse the relationship of provider level KAP with institutional level trends of antimicrobial resistance in a tertiary care hospital.
Methods: A cross-sectional KAP survey of medical faculty, residents, and interns in various departments using a questionnaire was complemented by a 12-month retrospective observation study of antimicrobial resistance data derived from records of the hospital microbiology laboratory, and prescription registers. Descriptive statistics, chi-square tests and ANOVA/t-tests were used to compute and compare KAP scores amongst the professional ranks. Analysis of resistance data was performed by organism, antimicrobial category (WHO AWaRe classification), specimen type and hospital unit.
Results: There was a measurable KAP gap with mean knowledge, attitude, and practice scores of 66.8%, 79.0%, and 63.5%, respectively, and was more apparent amongst junior staff. Overall, 38.6% of 1,842 clinical isolates were found to be multidrug-resistant organisms (MDROs). Highest resistance was found for Acinetobacter spp. (71.2%) and Klebsiella spp. (64.8%). Resistance against WHO “Watch” category antimicrobials (52.7%) was higher than to “Access” agents (28.4%). The resistance in intensive care unit (ICU) isolates was consistently higher and increasing more rapidly than general wards. There was a high positive correlation between knowledge and practice scores (r = 0.58, p<0.001).
Conclusions: Results show that there is a general lack of congruence among positive attitudes towards AMS, knowledge and practices in rational use of antimicrobials, especially among junior healthcare workers. Higher tier (Watch and Reserve) resistance data shows a concurrent increase in resistance, particularly in the ICU, highlighting the importance of structured, hierarchy-based stewardship education, policy enforcement and resistance surveillance.