Clinician perceptions and attitudes towards antimicrobial use, resistance and stewardship in a Thai acute care setting

Nantanit Sutthiruk 1, Mari Botti 1,2, Julie Considine 1,3, Andrea Driscoll 1,4, Ana Hutchinson 1,2, Kamthorn Malathum 5

Deakin University, Geelong, Victoria, Australia

Epworth HealthCare, Melbourne, Victoria, Australia

Eastern Health, Melbourne, Victoria, Australia

Austin Health, Melbourne, Victoria, Australia

Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand


Antimicrobial resistance (AMR) is a major healthcare problem worldwide. Inappropriate use of antimicrobials accelerates emergence of AMR. Successful implementation of antimicrobial stewardship (AMS) programs designed to improve the use of antimicrobials in hospitals is dependent on full engagement of clinicians. The aim of this study was to describe clinicians’ perceptions and attitudes towards antimicrobial use, resistance and stewardship interventions in the Thai acute care setting.

A paper-based survey was distributed to doctors, nurses and pharmacists at a 1,000-bed university hospital in Bangkok. A total of 1,087 clinicians participated: 613 nurses, 392 doctors and 82 pharmacists. Data were collected between November and December 2015.

Inappropriate antimicrobial prescriptions for inpatients were estimated at 26-50% by 41% of participants (n=445). A further 42% estimated that inappropriate surgical prophylaxis orders occurred in 10-25% of patients. Patients with community-acquired infection were ranked as the group with the highest levels of inappropriate antimicrobial orders while patients with immunosuppressive conditions were ranked as the lowest risk group by all participants. Pharmacists were more likely to report that inappropriate antimicrobial orders are more common in surgical patients (excluding surgical prophylaxis) compared with doctors and nurses (P< 0.001). Doctors were more likely than nurses to report that patients being treated in the VIP ward are prescribed inappropriate antimicrobials (P< 0.001).

AMS programs have a significant influence on evidence-based antimicrobial use. Clinicians’ attitudes and perceptions related to AMS are important to ensure that AMS programs are developed that address areas relevant to local clinical needs.

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