Antimicrobial stewardship (AMS) is a critical component of healthcare systems aimed at ensuring the rational use of antimicrobial agents. Along with infection prevention and control and patient safety, AMS forms one of the three pillars of healthcare quality improvement. Despite the availability of effective antimicrobials, inappropriate prescribing practices have contributed to the rapid emergence of antimicrobial resistance (AMR), resulting in increased morbidity, mortality, and healthcare costs worldwide^1,2,3.

Studies from India and other low- and middle-income countries have reported inappropriate antimicrobial prescribing driven by diagnostic uncertainty, patient expectations, and lack of awareness of stewardship principles. Understanding healthcare professionals’ knowledge, attitudes, and practices toward antimicrobial stewardship is essential for designing effective interventions^4,5. This study aimed to assess the KAP of healthcare professionals regarding antimicrobial stewardship in a tertiary care hospital.

METHODS

Study Design and Setting

This was a hospital-based cross-sectional observational study conducted at Kamineni Hospital, Kamineni Academy of Medical Sciences and Research Centre (KAMSRC), LB Nagar, Hyderabad, India.

Study Participants

The study included final-year medical students, junior residents, senior residents, consultants, nursing staff, and faculty members involved in patient care.

Study Tool

A validated questionnaire comprising 15 questions with 58 sub-sections was used to assess knowledge (29 items), attitude (5 items), and practice (24 items) related to antimicrobial stewardship. Responses were recorded on a 5-point Likert scale ranging from “strongly disagree” (1) to “strongly agree” (5).

Scoring and Data Analysis

Scores were categorized as good (≥75%), average (50–74%), or poor (<50%). Data were analyzed using SPSS software. Descriptive statistics were presented as frequencies and percentages. Pearson’s Chi-square test was used to assess associations, with statistical significance set at p <0.05.

RESULTS

Overall KAP Performance

Good knowledge of antimicrobial stewardship principles was observed in 62% of participants, while 71% demonstrated a positive attitude toward antimicrobial stewardship programs. In contrast, only 48% of respondents exhibited good antimicrobial prescribing practices.

Profession-wise Analysis

Consultants and senior residents had significantly higher knowledge and practice scores compared to medical students, junior residents, and nursing staff. Practice gaps were particularly evident in routine antimicrobial review, de-escalation, and multidisciplinary consultation^8,9.

Table 1: Distribution of Knowledge, Attitude and Practice Levels

Figure 1: Distribution of Knowledge, Attitude, and Practice Levels

Table 2. Profession-wise Distribution of Knowledge, Attitude, and Practice Scores

Figure 2. Profession-wise Comparison of Antimicrobial Stewardship Practices

Despite adequate knowledge across professional categories, antimicrobial stewardship practices were suboptimal among junior clinicians and nursing staff.

Table 3. Responses to Key Antimicrobial Prescribing Practices

Figure 2.The lowest compliance was seen in consultation-based prescribing and IV-to-oral switch strategies.

Table 4. Case Scenario–Based Practice Responses

Overuse of antibiotics was common in self-limiting conditions such as acute bronchitis and postoperative prophylaxis.

Figure 4. Correct Antimicrobial Decision-Making in Case Scenarios

Clinical decision-making varied widely, with notable misuse of antibiotics in respiratory and surgical settings.

Table 5. Association Between Knowledge and Practice

*Statistically significant p-value 0.001*

Higher knowledge scores were significantly associated with better antimicrobial prescribing practice

Case-Based Practice Assessment

Inappropriate antimicrobial use was commonly observed in self-limiting conditions such as acute bronchitis and uncomplicated diarrhea. Overuse of antibiotics for surgical prophylaxis was also reported.

Association Between Knowledge and Practice

A statistically significant association was found between higher knowledge scores and appropriate antimicrobial prescribing practices (χ² = 12.4; p = 0.001).

DISCUSSION

This study demonstrates that although healthcare professionals possess adequate knowledge and favorable attitudes toward antimicrobial stewardship, these do not consistently translate into optimal clinical practices. Similar findings have been reported in previous studies from India and other countries, highlighting a persistent gap between knowledge and practice^10,11,12.

The lower practice scores among junior clinicians and nursing staff emphasize the need for targeted educational interventions^14,15. Limited multidisciplinary involvement and reliance on empirical prescribing further highlight structural barriers to effective stewardship implementation. Strengthening antimicrobial stewardship programs through continuous training, audit and feedback, and real-time microbiology support is essential.

CONCLUSIONS

Healthcare professionals demonstrated good awareness and positive attitudes toward antimicrobial stewardship; however, antimicrobial prescribing practices remain suboptimal. Institutional strengthening of antimicrobial stewardship programs, continuous professional education, and multidisciplinary collaboration are critical to improving antimicrobial use and combating antimicrobial resistance.

DECLARATIONS

Ethics approval and consent to participate

The study protocol was approved by the Institutional Ethics Committee of Kamineni Hospital, Kamineni Academy of Medical Sciences and Research Centre (KAMSRC), LB Nagar, Hyderabad, India. Informed consent was obtained from all participants.

Funding: Nil

Conflicts of interests: Nil

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