Physician Knowledge, Attitudes, and Perceptions of Facility-Wide Antibiograms in Southern Sri Lanka: A Pre-Implementation Study

Abstract

Antimicrobial resistance (AMR) is among the top ten public health threats, disproportionately threatening low- and middle-income countries (LMICs), where microbiologic diagnostic capacity and antimicrobial susceptibility testing are limited. Antibiograms are practical, paper-based, or electronic tools that display summary data of local antibiotic susceptibility trends. Antibiograms can guide physicians in identifying appropriate empiric antimicrobial treatment when microbiologic culture data are not available. There is limited literature regarding the development and implementation of antibiograms in low-resource settings. The primary aim of this qualitative study was to explore physicians’ knowledge, attitudes, and perceptions (KAP) to determine factors that could impact the development and implementation of antibiograms in a tertiary care center in southern Sri Lanka. This qualitative study was conducted from June to August 2023 at the largest, public tertiary care hospital in the Southern Province. Our research team used convenience sampling to recruit physicians working in the pediatric and adult medical wards of the hospital. Participants were asked a total of 30 questions on four topics: Antibiotic Prescribing Practices, Knowledge of Antimicrobial Resistance, Attitudes towards Antimicrobial Resistance, and Knowledge of Antibiograms, as assessed in three stages. A sample antibiogram was utilized during the last section to understand how physicians interacted with and used the antibiogram. The study enrolled 31 critical informant physicians, including 20 adult physicians and 11 pediatricians. The majority (21, 68%) were male, had graduated medical school in the 2010s (16, 52%), and had practiced medicine for less than ten years (18, 58%). The results suggest that physicians are receptive to antibiograms, would find them a valuable tool in their practice, and are open to being trained on using them in their prescribing practice.