Evaluation of Faculty and Resident Physicians' Knowledge and Perceptions about Antimicrobial Use and Resistance: A Web Based Survey

Background: Antimicrobial resistance (AMR) has become a public health concern worldwide. In 2002 Jackson Memorial Hospital (JMH) implemented an Antimicrobial Stewardship Program (ASP) focused on selective formulary restrictions. The ASP was recently rebranded with a greater focus on education and information feedback. Objective: To assess the knowledge, attitudes, and perceptions of faculty and resident physicians as a prelude to the development of innovative solutions to improve antimicrobial use at JMH and the U of Miami. Methods: A 68-item, web-based anonymous survey was distributed to faculty and resident physicians in 11 specialties (adult and pediatric) at the U of Miami and JMH. Included were questions regarding the importance of appropriate use of antimicrobials, beliefs about causes of antimicrobial resistance, and attitudes towards interventions designed to address the problem. Knowledge was assessed with 10 clinical questions of various levels of difficulty. The knowledge total score was defined as the percentage of correct answers. Results: The survey was completed by 609 physicians: 54% faculty, 40% women, and 36% foreign medical graduates (FMG). 50% were not familiar with our ASP; 24% stated they often prescribed an antimicrobial even though it might be the wrong one; 90% were concerned about AMR when prescribing antimicrobials; 94% thought that more appropriate use of antimicrobials will decrease AMR; and 62% thought that inappropriate use of antimicrobials is professionally unethical. Approximately the same proportion (%) of faculty and residents agreed that antimicrobials are overused nationally (94.3 vs. 94.5) and locally (72.4 vs. 79.3), and that other doctors overprescribe antimicrobials (62.7 vs. 61.3). A significantly lower proportion of faculty than residents (9.6 vs. 16.7, p = 0.010) agreed that they themselves overprescribe antimicrobials. The overall mean (± SD) knowledge score (%) was 67 ± 30 and there were no differences by sex or FMG; however, faculty scored statistically significantly lower than residents (64 ± 32 vs. 72 ± 27, p = 0.001). Mean scores were highest for specialists in infectious diseases (87 ± 30), critical care (78± 28), and internal medicine (75 ± 26). The % of correct responders was lowest for questions on management of anaerobic infections (50.7) and extended spectrum beta-lactamase (ESBL) positive bacteremia (37.8). Conclusions: The majority of physicians agreed that antimicrobials are overused, that better use of antimicrobials will reduce AMR and that misuse of antimicrobials is professionally unethical. Antimicrobial stewardship efforts should capitalize on these perceptions to improve antimicrobial use. The finding that most physicians think others misuse antimicrobials while most do not think they themselves misuse antimicrobials highlights a potential lack of awareness that must be addressed.