Knowledge, Attitudes and Perceptions of Healthcare Workers on Antimicrobial Stewardship and Antibiotic Use: A Nationwide Multi-Center Study in Bangladesh

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Abu Sayem, Md. Akram Hossain, Md. Abdus Salam, and 15 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7726756/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Nov, 2025 Read the published version in Discover Public Health → Version 1 posted 10 You are reading this latest preprint version Abstract Background Antimicrobial resistance (AMR) disproportionately affects low and middle income countries (LMICs) including Bangladesh, driven by poorly implemented infection prevention and control (IPC) and misuse of antimicrobials. Robust Antimicrobial Stewardship (AMS) programs mitigate this risk by optimizing prescribing to best-practice standards. This study aimed to assess healthcare workers’ (HCWs) knowledge, attitude and perception (KAP) toward AMS. Methods An online questionnaire was shared via IPC Alliance BD to different health-related institutes and hospitals, inviting voluntary and anonymous participation of HCWs on KAP between January to March 2025. Results A total of 721 participants from 171 hospitals and institutes (78 public and 93 private), comprising 29% medical officers or equivalent, 29% nurses, 28% professors or equivalent and 14% administrative staff and other roles were enrolled. The average age was 36 years, and females accounted for 54% of respondents. Overall, 43% of respondents were familiar with the term AMS, reached through various sources. Only 11% received AMS training, and 18% had access to standard treatment guidelines. Despite 66% reporting availability of culture and sensitivity (C/S) testing, only 26% routinely recommended C/S and 15% shared an antibiogram. Empirical therapy predominated (> 94%), with a 60% preference for broad-spectrum agents. However, 67% believed rational use and proper IPC can reduce AMR. Knowledge, attitudes, and perceptions varied significantly by age, gender, and education (P < 0.05). Conclusion Antimicrobial resistance in Bangladesh necessitates strengthened laboratory capacity, expanded public awareness, and improved healthcare worker’s KAP via structured training and continuous monitoring, with robust antimicrobial stewardship as the operational benchmark. Antimicrobial stewardship Antibiotic use Healthcare workers Knowledge attitudes perceptions Bangladesh Figures Figure 1 Introduction Antimicrobial resistance (AMR) is a significant global public health threat, particularly in low- and middle-income countries (LMICs). The Global Research on Antimicrobial Resistance (GRAM) warns that drug-resistant bacterial infections could kill 39 million people from 2025 to 2050, roughly three deaths a minute [ 1 ]. Due to its severity and devastating consequences like prolonged sufferings, increased risk of death and exorbitant cost, WHO declared AMR as silent pandemic [ 2 ]. In 2021, it was estimated that 1.14 million deaths were directly attributable to AMR [ 3 ]. There is a steep financial burden associated with AMR, amounting to roughly $ 2 billion each year and an anticipated $ 1 trillion losses by 2050, underscoring its macroeconomic impact [ 2 , 4 , 5 ]. AMR develops due to inappropriate use of antimicrobials, especially antibiotics, which provokes the selection of resistant microorganisms [ 5 , 6 ]. On the other hand, AMR can also be developed by acquiring resistant microorganisms particularly from hospitals due to improper Infection Prevention and Control (IPC) [ 7 ]. Antimicrobial Stewardship (AMS) programs demonstrably improve prescribing behavior of the physicians, promote rational Antimicrobial Use (AMU), limit prophylactic overuse, educate patient, enhance compliance and coordinate with IPC teams [ 8 , 9 , 10 ]. The programs yield clinical, microbiological, and economic benefits-optimizing therapy, reducing unnecessary use and thereby enhance overall care quality and patient safety [ 11 , 12 ]. WHO developed an AMS assessment checklists with essential core components (leadership and commitment, accountability and responsibility, AMS action, education and training, monitoring and surveillance, reporting and feedback) that are applicable in almost all settings [ 13 , 14 , 15 , 16 ]. The monitoring and surveillance data can help explain how AMR is conceptualized, current prescribing is rationalized, and how broad principles are adopted according to contexts and countries [ 17 , 18 , 19 ]. Despite clear need and urgency, there is a paucity of AMS research in LMICs including Bangladesh, particularly studies assessing psychometric dimensions such as knowledge, attitudes, and perceptions [ 20 , 21 ]. Unlike developed countries like Australia, Sweden, USA and United Kingdom, AMS is still an evolving program in most of the LMICs including Bangladesh [ 13 , 22 , 23 , 24 , 25 ]. Weak enforcement of prescribing regulations enables inappropriate use, alongside widespread over-the-counter antibiotic sales without valid prescription are prevailing factors in most of the LMICs [ 5 , 26 ]. AMS programs reduce inappropriate antibiotic use and promote better clinical practice through coordinated professional education, public awareness campaigns, and complementary system-wide interventions [ 27 , 28 ]. WHO prioritizes strengthening healthcare professionals’ knowledge to curb AMR, yet Bangladeshi HCWs’ knowledge and perceptions of AMS and antibiotic use remain largely undocumented, highlighting a critical evidence gap [ 2 , 29 ]. To analyze these gaps, we conducted this study among HCWs working in different government and private hospitals in Bangladesh. Methods 2.1 Study population and settings This study was a fully anonymous voluntary survey using a survey link shared through IPC Alliance BD network and personal communication with HCWs from academic and professional bodies, government and non-government organizations (NGOs). We collected responses from 838 participants between January to March 2025. After removing incomplete and missing data, 721 participants from a total of 171 hospitals and institutes including 78 government and 93 private across 37 districts were finally enrolled in this study. This convenience sample represented around one-third of all hospitals and institutions in the country comprising both academic and non-academic hospitals, public and private nursing colleges and institutes, clinics, and laboratories. Participants included a broad cadre of health professionals, practicing and academic physicians (medical officers to professors), administrative physicians (principals, directors, civil surgeons, curators), dental surgeons, postgraduate trainees, nurses (junior staff to principals), and microbiologists from all eight administrative divisions of Bangladesh. The pharmacists, physiotherapists and medical students were not included in this study. 2.2 Data collection We used a semi-structured KAP questionnaire to obtain information on AMU, AMS and AMR. The tool was developed based on literature review and expert opinion. The questionnaire was piloted in two health facilities for testing clarity and relevance but the data from the pilot study were not included. There were 30 items in the questionnaire, evenly divided into 10 knowledge, 10 attitudes and 10 perception based questions. The knowledge domain primarily focused on AMR, familiarity with national AMS guidelines and standard practices. The attitude questions addressed opinions on AMS policies and procedures, and the use of antibiotics. Perception-based questions assessed compliance with various AMS measures, adherence to antibiotic use guidelines, evidence-based prescriptions, and education on appropriate antibiotic use. For non-practicing respondents (nurses and others), the domain practice was replaced with observed practice and few questions were skipped. It took approximately 25 to 30 minutes to complete online responses. 2.3 Statistical analysis The responses from the KAP questionnaire were summarized into frequency, percentage, and mean with standard deviation (SD). Chi-square test was done to identify the socio-demographic factors associated with KAP of HCWs regarding AMS and AMU. All statistical analyses were performed using SPSS version 25.0 software. 2.4 Declarations: We followed each steps of Helsinki declaration regarding ethical approval and consent to participate. After sharing of purpose, risks and benefits, freedom to participate or reject, withdrawal at any time, estimated time of responses, privacy and anonymization, use of data and other relevant information according to Helsinki declaration. Ethical approval: This study was approved by Institutional Review Board of Apollo Imperial Hospitals Ltd. with Ref. No: AIHL/IRB/25091, dated on 10 th November 2024. Consent to participate: After sharing the purpose of the study through emails with shared link, all respondents voluntarily provided their consent for participation. Results Out of 721 respondents, age was categorized as young, adult, and old, with the young group predominating at 77.1% and the mean age in years was 35.73±9.93. Gender-wise, higher respondent was from female (54.0%). By role, 57.3% were physicians, 28.7% nurses, and 14.0% other officials, spanning clinical, academic, and administrative designations across medicine, nursing, microbiology, and hospital leadership. Household expenditure clustered at BDT 35,000–50,000 (38.4%) and >BDT 50,000 (31.8%), with ~7% <BDT 20,000. Educational attainment included 43.7% bachelor’s and 36.9% postgraduate degrees, with most working in inpatient care (58.3%) or teaching roles (24.8%) (Table 1). Table 1. Socio-demographic and socio-economic characteristics of study participants (n=721) Characteristics Number % Age group 22-42 years (young) 556 77.1 43-63 years (adult) 152 21.1 ≥64 years (old) 13 1.8 Gender Male 332 46.0 Female 389 54.0 Type of healthcare workers Nurse group 207 28.7 Medical Officer and equivalent 209 29.0 Professor and equivalent 204 28.3 Others 101 14.0 Monthly expenditure in BDT 50000 229 31.8 Education Bachelor 315 43.7 Post-graduation (ongoing) 140 19.4 Post-graduation (completed) 266 36.9 Working places Indoor 420 58.3 Outdoor 62 08.6 Teaching 179 24.8 Laboratory 28 03.9 Emergency 14 01.9 Others (various duties and administration) 18 02.5 AMS awareness was limited (43%), with AMS committees present in 14% of facilities and 12% were of aware of implementation plans; while 17% reported AMS discussions in monthly quality meetings and 4% noted regular AMS review meetings. Only 11% had received AMS training (7% one‑day; 4% three‑day), 18% reported facility standard treatment guidelines, and 12% said management issues C/S‑based therapy alerts. Despite 71% reporting a microbiology department and 66% access to C/S testing, only 26% advised C/S when indicated, 15% received antibiograms, and targeted therapy was reported by 6% versus 77% empirical use (17% unsure). Exposure to AMS messaging reached 43% via posters, trainings, emails, awareness‑week events, or NGO activities; narrow‑spectrum use was observed by 8% versus 72% broad‑spectrum (20% unsure). Most respondents endorsed harms from antibiotic misuse (69%) and believed rational use with strong IPC reduces AMR (67%); only 7% required prior approval for reserve antibiotics (Table 2). Table 2. AMS related knowledge, attitude and perception including relevant resources (n=721) Characteristics Number % Familiar with the term AMS Yes 312 43.3 No 409 56.7 Availability of AMS committee Yes 104 14.4 No 329 45.6 Don’t know 288 39.9 Monthly AMS meeting held Yes 32 04.4 No 467 64.8 Don’t know 222 30.8 AMS implementation plan developed Yes 86 11.9 No 267 37.0 Don’t know 368 51.0 AMS discussed in regular monthly meeting Yes 122 16.9 No 357 49.5 Don’t know 242 33.6 Availability of clinical guidelines or standard treatment guidelines (STG) Yes 129 17.9 No 375 52.0 Don’t know 217 30.1 Availability of microbiology department in the facility Yes 512 71.0 No 209 29.0 Availability of culture and sensitivity (C/S) test in the facility Yes 479 66.4 No 200 27.7 Don’t know 42 05.8 Advice C/S whenever indicated Yes 186 25.8 No 535 74.2 Modify antibiotic following C/S report Yes 168 23.3 No 466 64.6 Don’t know 87 12.1 Preparation and sharing of antibiogram by the facility Yes 112 15.5 No 309 42.9 Don’t know 300 41.6 Start empirical therapy Yes 552 76.6 No 42 05.8 Don’t know 127 17.6 AMS training received Yes 80 11.1 No 641 88.9 Duration of AMS training One day 50 06.9 Three days 30 04.2 No training 641 88.9 AMS awareness communicated through poster, emails, training or by NGOs Yes 308 42.7 No 338 46.9 Don’t know 75 10.4 Management alert to modify antibiotic therapy based on C/S results Yes 89 12.3 No 445 61.7 Don’t know 187 26.0 Use of broad spectrum antibiotics over narrow spectrum Yes 516 71.6 No 61 08.5 Don’t know 144 20.0 Misuse of antibiotics can affect Patients 138 19.1 Family 20 02.8 Both 496 68.8 Entire community 46 06.4 Don’t know 21 02.9 Rational use of antibiotics and practice of IPC can reduce AMR Yes 481 66.7 No 151 20.9 Don’t know 89 12.3 Prior approval is needed to prescribe reserve group antibiotics Yes 50 06.9 No 439 60.9 Don’t know 232 32.2 We also analyzed the attitude and perception of care providers on AMS practice objectively. Around 60% perceived antibiotic overuse in their facilities, and 69% agreed AMR warrants focused attention. Only 12% reported access to trained infectious disease physicians, while 45% said they educate patients and families on rational antibiotic use. Over 20% perceived patient demand for stronger antibiotics, 12% felt colleague pressure toward broad‑spectrum agents, and 21% cited pressure from pharmaceutical companies (Table 3). Table 3. Attitude and perception of care providers on AMS practices (n=721) Response Number % Antibiotics are overused at our healthcare facility Strongly agree 142 19.7 Agree 288 39.9 Neutral 127 17.6 Disagree 140 19.4 Strong disagree 24 03.3 AMR is a problem at our healthcare facility Strongly agree 193 26.8 Agree 303 42.0 Neutral 93 12.9 Disagree 64 08.9 Strong disagree 68 09.4 Trained infectious diseases physicians are available at our healthcare facility Strongly agree 34 04.7 Agree 58 08.0 Neutral 218 30.2 Disagree 377 52.3 Strong disagree 34 04.7 Patients and their family members are educated on rational use of antibiotics Strongly agree 68 09.4 Agree 254 35.2 Neutral 276 38.3 Disagree 104 14.4 Strong disagree 19 02.6 Patients or their family members demand higher antibiotics Strongly agree 42 05.8 Agree 105 14.6 Neutral 347 48.1 Disagree 167 23.2 Strong disagree 60 08.3 Pressure from seniors or colleagues on prescribing antibiotics Strongly agree 30 04.2 Agree 53 07.4 Neutral 355 49.2 Disagree 185 25.7 Strong disagree 98 13.6 Pharmaceutical companies influence my decision on prescribing antibiotics Strongly agree 40 05.5 Agree 106 14.7 Neutral 330 45.8 Disagree 150 20.8 Strong disagree 95 13.2 Age, gender, and education were significantly associated with AMS KAP. Older and adult respondents were more familiar with AMS than younger peers (P<0.001), with the oldest group most frequently identifying AMS committees (31%). Modification of antibiotics following C/S increased with age, from 22% in the young group to 27% in adults and 54% in older respondents (P<0.001). Recognition of the role of antibiograms was highest in older respondents (31%) and lowest in adults (10%) (P<0.006). Overall, 43% had received communication on AMS importance, with higher engagement among young and old groups compared to adults (39%) (P<0.039). Male respondents demonstrated higher AMS familiarity and practice indicators than females: familiarity 49% vs 38% (P<0.002), C/S recommendation 37% vs 16% and modification based on C/S 34% vs 14% (both P<0.001), and antibiogram reporting 18% vs 14% (P<0.006). Empirical therapy reporting was higher among males (90%) than females (60%), with 29% of females (predominantly nurses) were unsure of the term, indicating a pronounced sex‑based knowledge gap (P<0.001). AMS training was more common in males (15%) than females (8%) (P<0.002); males more often reported AMS communications (52%) yet favored broad‑spectrum over narrow‑spectrum agents (60%) (P<0.001). Approval requirements for reserve antibiotics were more frequently reported by males (12% vs 3%), though unfamiliarity with the process remained substantial (26% of males; 37% of females; P<0.001). Postgraduates and postgraduate trainees outperformed graduates in familiarity with AMS, awareness of teams/committees and implementation plans, and recognition of AMS importance (all P<0.001). Postgraduate doctors more frequently recommended C/S (42%) and modified therapy accordingly (38%) than counterparts (P<0.001); postgraduate trainees more often reported guideline/STG availability (27%) than graduates (P<0.001). Empirical therapy reporting was lower among bachelor‑level nurses (61%) than others (89% and 88%) (P<0.001), while seniors used broad‑spectrum antibiotics more than juniors (P<0.001) (Table 4). Table 4. Association between socio-demographic factors and KAP on AMS (n=721) Characteristics P value Are you familiar with the term AMS? Yes (%) No (%) Don’t know (%) Young 214 (38.5) 342 (61.5) 0.001 Adult 89 (58.6) 63 (41.4) Old 09 (69.2) 04 (30.8) Is there any AMS committee/teams? 0.037 Young 80 (14.4) 242 (43.5) 234 (42.1) Adult 20 (13.1) 79 (52.0) 53 (34.9) Old 04 (30.8) 08 (61.5) 01 (07.7) Do you modify antibiotics following C/S report? 0.001 Young 120 (21.6) 378 (68.0) 58 (10.4) Adult 41 (27.0) 84 (55.3) 27 (17.8) Old 07 (53.8) 04 (30.8) 02 (15.4) Does your facility prepare and share antibiogram? 0.006 Young 93 (16.7) 221 (39.7) 242 (43.5) Adult 15 (09.9) 81 (53.3) 56 (36.8) Old 04 (30.8) 07 (53.8) 02 (15.4) Does your management alert about C/S results to modify antibiotic therapy? 0.045 Young 68(12.2) 345 (62.1) 143 (25.7) Adult 16 (10.5) 93 (61.2) 43 (28.3) Old 05 (38.5) 07 (53.8) 01 (07.7) Have you been communicated through posters, emails or NGOs on importance of AMS? 0.039 Young 240 (43.2) 251 (45.1) 65 (11.7) Adult 59 (38.8) 83 (54.6) 10 (06.6) Old 09 (69.2) 04 (30.8) 00 (00.0) Do you need prior approval before prescribing reserve group antibiotics? 0.040 Young 35 (06.3) 349 (62.8) 172 (30.9) Adult 12 (07.9) 82 (53.9) 58 (38.2) Old 03 (23.1) 08 (61.5) 02 (15.4) Are you familiar with the term AMS? 0.002 Male 164 (49.4) 168 (50.6) Female 148 (38.0) 241 (62.0) Does your facility conduct monthly AMS meeting? 0.001 Male 13 (03.9) 248 (74.7) 71 (21.4) Female 19 (04.9) 219 (56.3) 151 (38.8) Do you suggest for C/S whenever indicated? 0.001 Male 123 (37.0) 209 (63.0) Female 63 (16.2) 326 (83.8) Do you modify antibiotics following C/S report? 0.001 Male 114 (34.3) 191 (57.5) 27 (08.1) Female 54 (13.9) 275 (70.7) 60 (15.4) Does your facility prepare and share antibiogram? 0.006 Male 58 (17.5) 157 (47.3) 117 (35.2) Female 54 (13.9) 152 (39.1) 183 (47.0) Do you start impirical therapy? 0.001 Male 299 (90.1) 18 (05.4) 15 (04.5) Female 253 (65.0) 24 (06.2) 112 (28.8) Did you receive any training on AMS? 0.002 Male 50 (15.1) 282 (84.9) Female 30 (07.7) 359 (92.3) Does your management alert you to modify antibiotic therapy based on C/S results? 0.001 Male 63 (19.0) 203 (61.1) 66 (19.9) Female 26 (06.7) 242 (62.2) 121 (31.1) Have you been communicated through posters, emails or NGOs on importance of AMS? 0.001 Male 173 (52.1) 130 (39.2) 29 (08.7) Female 135 (34.7) 208 (53.5) 46 (11.8) Do you use broad spectrum antibiotics over narrow spectrum? 0.001 Male 198 (59.6) 57 (17.2) 77 (23.2) Female 114 (29.3) 99 (25.4) 176 (45.2) Do you think rational use of antibiotics and IPC can reduce AMR? 0.001 Male 254 (76.5) 62 (18.7) 16 (04.8) Female 227 (58.4) 89 (22.9) 73 (18.8) Do you need prior approval before prescribing reserve group antibiotics? 0.001 Male 39 (11.7) 206 (62.0) 87 (26.3) Female 11 (02.8) 233 (59.9) 145 (37.3) Are you familiar with the term AMS? 0.001 Bachelor 50 (15.9) 265 (84.1) PG ongoing 84 (60.0) 56 (40.0) Postgraduate 178 (66.9) 88 (33.1) Does your facility conducts monthly AMS meeting? 0.001 Bachelor 14 (04.4) 165 (52.4) 136 (43.2) PG ongoing 03 (02.1) 105 (75.0) 32 (22.9) Postgraduate 15 (05.6) 197 (74.1) 54 (20.3) Is there any AMS committee or teams in your facility? 0.001 Bachelor 40 (12.7) 131 (41.6) 144 (45.7) PG ongoing 20 (14.3) 51 (36.4) 69 (49.3) Postgraduate 44 (16.5) 147 (55.3) 75 (28.2) Is there any AMS implementation plan in your facility? 0.021 Bachelor 33 (10.5) 114 (36.2) 168 (53.3) PG ongoing 15 (10.7) 41 (29.3) 84 (60.0) Postgraduate 38 (14.3) 112 (42.1) 116 (43.6) Does your facility discuss AMS in regular monthly meeting? 0.001 Bachelor 66 (21.0) 129 (41.0) 120 (38.1) PG ongoing 13 (09.3) 72 (51.4) 55 (39.3) Postgraduate 43 (16.2) 156 (58.6) 67 (25.2) Is there any standard treatment guidelines available in your facility? 0.001 Bachelor 38 (12.1) 160 (50.8) 117 (37.1) PG ongoing 38 (27.1) 65 (46.4) 37 (26.4) Postgraduate 53 (19.9) 150 (56.4) 63 (23.7) Do you suggest for C/S whenever indicated? 0.001 Bachelor 50 (15.9) 265 (84.1) PG ongoing 25 (17.9) 115 (82.1) Postgraduate 111 (41.7) 155 (58.3) Do you modify antibiotics following C/S results? 0.001 Bachelor 46 (14.6) 219 (69.5) 50 (15.9) PG ongoing 20 (14.3) 115 (82.1) 05 (03.6) Postgraduate 102 (38.3) 132 (49.6) 32 (12.0) Does your facility prepare and share antibiogram? 0.001 Bachelor 48 (15.2) 102 (32.4) 165 (52.4) PG ongoing 26 (18.6) 58 (41.4) 56 (40.0) Postgraduate 38 (14.3) 149 (56.0) 79 (29.7) Do you start empirical therapy? 0.001 Bachelor 193 (61.3) 20 (06.3) 102 (32.4) PG ongoing 124 (88.6) 15 (10.7) 01 (00.7) Postgraduate 235 (88.3) 07 (02.6) 24 (09.0) Did you receive any training on AMS? 0.001 Bachelor 21 (06.7) 294 (93.3) PG ongoing 12 (08.6) 128 (91.4) Postgraduate 47 (17.7) 219 (82.3) Does your management alert you to modify antibiotic therapy based on C/S results? 0.001 Bachelor 18 (05.7) 193 (61.3) 104 (33.0) PG ongoing 25 (17.9) 91 (65.0) 24 (17.1) Postgraduate 46 (17.3) 161 (60.5) 59 (22.2) Have you been communicated through posters, emails or NGOs on importance of AMS? 0.003 Bachelor 109 (34.6) 166 (52.7) 40 (12.7) PG ongoing 68 (48.6) 58 (41.4) 14 (10.0) Postgraduate 131 (49.2) 114 (42.9) 21 (07.9) Do you use broad spectrum antibiotics over narrow spectrum? 0.001 Bachelor 150 (47.6) 36 (11.4) 129 (41.0) PG ongoing 139 (99.3) 01 (00.7) 00 (00.0) Postgraduate 227 (85.3) 24 (09.0) 15 (05.6) Do you think rational use of antibiotics and IPC can reduce AMR? 0.001 Bachelor 173 (54.9) 72 (22.9) 70 (22.2) PG ongoing 99 (70.7) 36 (25.7) 05 (03.6) Postgraduate 209 (78.6) 43 (16.2) 14 (05.3) N.B. MO: Medical Officer, PG: Postgraduation, NGO: Non-government organization, IPC: Infection prevention and control, C/S: Culture and sensitivity Discussion The knowledge, attitudes, and perceptions (KAP) of healthcare providers towards antimicrobial stewardship (AMS) are strongly influenced by demographic and professional characteristics, including age, education, and professional engagement. In our study, only 43% of providers were familiar with the term AMS, leaving nearly 57% were unfamiliar. This level of familiarity is substantially lower than that reported in a multi-country survey across Latin America, where only 23% of healthcare providers reported unfamiliarity with AMS [30]. This discrepancy highlights important regional variations in awareness that warrant context-specific strategies. Encouragingly, our study found that 43% of respondents received communication regarding antimicrobial resistance (AMR) and stewardship through posters, emails, training sessions, and campaigns organized by government and non-governmental agencies including globally recognized initiatives such as World Antimicrobial Awareness Week (WAAW). Similar modes of communication have been cited as effective tools in promoting AMS awareness in other settings, but their limited reach in our cohort suggests that existing outreach strategies may not be systematically adopted at the facility level. In terms of perception, a majority of respondents (68%) recognized that misuse of antibiotics, whether through overuse, underuse, irrational prescribing, or incomplete treatment increases morbidity, mortality, healthcare costs, and contributes directly to AMR. This aligns with findings from other international studies emphasizing the well-established link between irrational antibiotic use and antimicrobial resistance [30]. Two key pathways to preventing AMR have been consistently identified: the rational use of antimicrobials through AMS interventions and strict adherence to IPC measures. In our study, 67% of respondents acknowledged this, comparable to findings from Indian research reporting similar perceptions among healthcare professionals [31]. Nevertheless, a concerning 12% and 21% of participants either did not know about or did not believe in the impact of IPC compliance and rational antibiotic use, respectively. These gaps likely reflect underlying inadequacies in both access to accurate information and dissemination of standard treatment guidelines (STGs). Indeed, we found that only 18% of respondents reported access to STGs, a figure substantially lower than the 30-40% reported in Latin American countries [30]. This finding underscores the critical importance of developing and consistently implementing context-appropriate STGs for guiding therapy. Beyond knowledge and perceptions, major barriers were identified in clinical practice. Despite the presence of microbiology departments (71%) and C/S facilities (66%) in respondents’ institutions, only 26% routinely requested C/S testing and just 23% modified antibiotic regimens based on results. Furthermore, only 15.5% of laboratories prepared and shared antibiograms, a practice crucial for surveillance of local resistance patterns. This limited utilization contrasts sharply with recommendations from global stewardship frameworks, which emphasize the indispensability of antibiograms for promoting targeted rather than empirical therapy. The inadequate laboratory engagement observed in our study mirrors findings from other LMICs, where lack of systemic support for AMS program infrastructure restricts translation of knowledge into practice [32]. Institutional support for AMS was also found to be weak. Only 14% of facilities reported having an AMS committee, 12% had an implementation plan, and 17% discussed AMS activities in regular quality improvement meetings. Similarly, low proportions of respondents reported training opportunities (11%) and less managerial support on modifying therapy based on C/S results (12%). Collectively, these indicators reflect significant deficiencies in system-level commitment to AMS. Studies from other resource-limited settings have also documented such gaps, reinforcing the notion that without structured programs, AMS implementation remains fragmented and highly inconsistent [33]. The challenge of empirical therapy emerged prominently, as only 6% of respondents reported practicing targeted therapy. This finding is consistent with global observations of high empirical prescribing rates in similar settings, with validation from studies across South Asia that similarly emphasize over-reliance on empirical regimens [9,34]. Inadequate uptake of culture-based prescribing highlights the need for stronger policy enforcement and education to improve diagnostic stewardship. Another critical issue identified was antibiotic prescribing trends. More than 60% of respondents acknowledged frequent use of broad-spectrum antibiotics and recognized AMR as a pressing problem in their facilities. This self-reported trend mirrors results from the national point prevalence survey (PPS) in Bangladesh, which documented that over 64% of patients received antibiotics from the WHO “Watch” group, predominantly broad-spectrum agents [35]. These patterns were reinforced in our study, reflecting a persistent trend even when healthcare providers are cognizant of the risks associated with broad-spectrum use. The drivers of excessive and often inappropriate prescribing included patient demanded (21%), influence from pharmaceutical companies (21%), and pressure from senior colleagues (12%). These factors are in line with reports from India and other LMICs, where social and professional pressures significantly shape physicians’ antibiotic choices despite the availability of guidelines [36]. Finally, our analysis identified demographic factors such as age, gender, and education level as being significantly associated with KAP towards AMS. These associations have been corroborated in previous international studies, which suggest that targeted educational interventions tailored to specific sub-groups of healthcare workers may be more impactful than generalized campaigns [21,30,37]. Overall, our findings highlight critical gaps across awareness, practice, system-level support, and prescribing behavior. They resonate with challenges widely reported in other LMIC settings, but also point to context-specific solutions that prioritize expanding access to STGs, strengthening laboratory networks, ensuring facility-level stewardship committees, and addressing the socio-professional drivers of prescribing behavior. 4.1 Limitation and strength Representativeness of the study is limited due to reliance on a convenience sample recruited via the IPC Alliance BD network and personal contacts, which may introduce selection bias and restrict external validity. Sub-national facilities were underrepresented among respondents, further constraining broadness across care levels and regions. Inclusion of both technical and non-technical staff, and prescribers and non-prescribers, raises the possibility of measurement and reporting biases (e.g., social desirability and underreporting of external pressures), which could affect estimates of determinants such as peer or pharmaceutical influence. The survey leveraged a large sample from diverse geographic areas and included participants from both public and private facilities, enhancing the breadth and contextual relevance of the findings. Inclusion of both prescribers and non-prescribers provided a comprehensive perspective on AMS knowledge, attitudes, and practices across professional roles, aligning with best-practice guidance to capture system-level determinants. Moreover, the patterns observed are consistent with prior literature on AMS/AMR KAP, supporting the credibility and triangulation of the results across settings. Conclusion This study identified substantive gaps in knowledge, attitudes, practices, and overall perceptions related to antimicrobial stewardship (AMS), indicating priority needs across provider behavior, laboratory capacity, and managerial coordination. These findings can directly inform the design, scaling, and strengthening of AMS in Bangladesh. Emphasis should be placed on strengthening antimicrobial stewardship through the following priorities: enhancing provider and community awareness; expanding access to laboratory diagnostics and evidence-based treatment services; reinforcing the laboratory network and promoting routine use of antibiograms; improving physicians’ prescribing practices; and ensuring strong managerial engagement to coordinate, monitor, and sustain AMS implementation. Collectively, a coordinated, multisectoral approach that integrates education, diagnostics, guideline-driven prescribing, and leadership accountability is essential to translate identified gaps into measurable gains in rational antimicrobial use and AMR mitigation. Declarations Author Contributions Conceptualization: Md. Akram Hossain, Faisal Chowdhury, Ayesha Ahmed Khan, Md. Abu Sayem Investigation: Md. Akram Hossain, Md. Abu Sayem, Tanveer Ahmed, Kakali Halder, Sabrina Monsur, Musabbir Rahaman, Ummey Shahnaz Parvin, Mahbub Ul Alam, Md. Faysal Bin Salah, S.M. Selimuzzaman, Fahmida Khanam, Pompy Dey, Sourav Nath, Md. Muid Sakib, Zahin Zeima Methodology, Statistical Analysis, Validation: Md. Abu Sayem, Md. Abdus Salam, Akram Hossain, Ayesha Ahmed Khan, Md. Faisal, Abu Sadat Mohammad Nurunnabi Writing - Original draft preparation: Md. Abu Sayem, Faisal Chowdhury Writing - Review and Editing : Md. Abdus Salam, Md. Abu Sayem, Md. Akram Hossain All authors have read and agreed to the published version of the manuscript. Funding information : There was no funding source for this study. Acknowledgement: We are grateful to our survey participants and hospital authorities for providing their support, valuable time and information. Conflicts of Interest: The authors declare no conflict of interest. Data availability: Data and data file are available with corresponding author. Clinical trial number : Not applicable. References Chris Dall. 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02:23:52","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":256512,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7726756/v1/4e1dd9c4b9c23e66a7250287.html"},{"id":93540536,"identity":"c7131464-6458-431c-a8e2-c04c32883f01","added_by":"auto","created_at":"2025-10-15 02:23:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1456458,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Methods\u003cstrong\u003e \u003c/strong\u003esection.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7726756/v1/d8e5b9286326f5aeb0f4487c.png"},{"id":97178221,"identity":"afa81e4a-25a6-4cb5-b8b3-7959ee39f63d","added_by":"auto","created_at":"2025-12-01 16:01:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2759564,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7726756/v1/b9810021-d7a8-4fc9-9f51-e5a15a4dbfde.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge, Attitudes and Perceptions of Healthcare Workers on Antimicrobial Stewardship and Antibiotic Use: A Nationwide Multi-Center Study in Bangladesh","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAntimicrobial resistance (AMR) is a significant global public health threat, particularly in low- and middle-income countries (LMICs). The Global Research on Antimicrobial Resistance (GRAM) warns that drug-resistant bacterial infections could kill 39\u0026nbsp;million people from 2025 to 2050, roughly three deaths a minute [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Due to its severity and devastating consequences like prolonged sufferings, increased risk of death and exorbitant cost, WHO declared AMR as silent pandemic [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In 2021, it was estimated that 1.14\u0026nbsp;million deaths were directly attributable to AMR [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. There is a steep financial burden associated with AMR, amounting to roughly \u003cspan\u003e$\u003c/span\u003e2\u0026nbsp;billion each year and an anticipated \u003cspan\u003e$\u003c/span\u003e1 trillion losses by 2050, underscoring its macroeconomic impact [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAMR develops due to inappropriate use of antimicrobials, especially antibiotics, which provokes the selection of resistant microorganisms [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. On the other hand, AMR can also be developed by acquiring resistant microorganisms particularly from hospitals due to improper Infection Prevention and Control (IPC) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Antimicrobial Stewardship (AMS) programs demonstrably improve prescribing behavior of the physicians, promote rational Antimicrobial Use (AMU), limit prophylactic overuse, educate patient, enhance compliance and coordinate with IPC teams [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The programs yield clinical, microbiological, and economic benefits-optimizing therapy, reducing unnecessary use and thereby enhance overall care quality and patient safety [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. WHO developed an AMS assessment checklists with essential core components (leadership and commitment, accountability and responsibility, AMS action, education and training, monitoring and surveillance, reporting and feedback) that are applicable in almost all settings [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The monitoring and surveillance data can help explain how AMR is conceptualized, current prescribing is rationalized, and how broad principles are adopted according to contexts and countries [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Despite clear need and urgency, there is a paucity of AMS research in LMICs including Bangladesh, particularly studies assessing psychometric dimensions such as knowledge, attitudes, and perceptions [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eUnlike developed countries like Australia, Sweden, USA and United Kingdom, AMS is still an evolving program in most of the LMICs including Bangladesh [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Weak enforcement of prescribing regulations enables inappropriate use, alongside widespread over-the-counter antibiotic sales without valid prescription are prevailing factors in most of the LMICs [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. AMS programs reduce inappropriate antibiotic use and promote better clinical practice through coordinated professional education, public awareness campaigns, and complementary system-wide interventions [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. WHO prioritizes strengthening healthcare professionals\u0026rsquo; knowledge to curb AMR, yet Bangladeshi HCWs\u0026rsquo; knowledge and perceptions of AMS and antibiotic use remain largely undocumented, highlighting a critical evidence gap [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. To analyze these gaps, we conducted this study among HCWs working in different government and private hospitals in Bangladesh.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study population and settings\u003c/h2\u003e\u003cp\u003eThis study was a fully anonymous voluntary survey using a survey link shared through IPC Alliance BD network and personal communication with HCWs from academic and professional bodies, government and non-government organizations (NGOs). We collected responses from 838 participants between January to March 2025. After removing incomplete and missing data, 721 participants from a total of 171 hospitals and institutes including 78 government and 93 private across 37 districts were finally enrolled in this study. This convenience sample represented around one-third of all hospitals and institutions in the country comprising both academic and non-academic hospitals, public and private nursing colleges and institutes, clinics, and laboratories. Participants included a broad cadre of health professionals, practicing and academic physicians (medical officers to professors), administrative physicians (principals, directors, civil surgeons, curators), dental surgeons, postgraduate trainees, nurses (junior staff to principals), and microbiologists from all eight administrative divisions of Bangladesh. The pharmacists, physiotherapists and medical students were not included in this study.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Data collection\u003c/h2\u003e\u003cp\u003eWe used a semi-structured KAP questionnaire to obtain information on AMU, AMS and AMR. The tool was developed based on literature review and expert opinion. The questionnaire was piloted in two health facilities for testing clarity and relevance but the data from the pilot study were not included. There were 30 items in the questionnaire, evenly divided into 10 knowledge, 10 attitudes and 10 perception based questions. The knowledge domain primarily focused on AMR, familiarity with national AMS guidelines and standard practices. The attitude questions addressed opinions on AMS policies and procedures, and the use of antibiotics. Perception-based questions assessed compliance with various AMS measures, adherence to antibiotic use guidelines, evidence-based prescriptions, and education on appropriate antibiotic use. For non-practicing respondents (nurses and others), the domain practice was replaced with observed practice and few questions were skipped. It took approximately 25 to 30 minutes to complete online responses.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Statistical analysis\u003c/h2\u003e\u003cp\u003eThe responses from the KAP questionnaire were summarized into frequency, percentage, and mean with standard deviation (SD). Chi-square test was done to identify the socio-demographic factors associated with KAP of HCWs regarding AMS and AMU. All statistical analyses were performed using SPSS version 25.0 software.\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003cstrong\u003e2.4\u003c/strong\u003e \u003cstrong\u003eDeclarations:\u003c/strong\u003e We followed each steps of Helsinki declaration regarding ethical approval and consent to participate. After sharing of purpose, risks and benefits, freedom to participate or reject, withdrawal at any time, estimated time of responses, privacy and anonymization, use of data and other relevant information according to Helsinki declaration.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003eThis study was approved by Institutional Review Board of Apollo Imperial Hospitals Ltd. with Ref. No: AIHL/IRB/25091, dated on 10\u003csup\u003eth\u003c/sup\u003e November 2024.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eAfter sharing the purpose of the study through emails with shared link, all respondents voluntarily provided their consent for participation.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOut of 721 respondents, age was categorized as young, adult, and old, with the young group predominating at 77.1% and the mean age in years was 35.73±9.93. Gender-wise, higher respondent was from female (54.0%). By role, 57.3% were physicians, 28.7% nurses, and 14.0% other officials, spanning clinical, academic, and administrative designations across medicine, nursing, microbiology, and hospital leadership. Household expenditure clustered at BDT 35,000–50,000 (38.4%) and \u0026gt;BDT 50,000 (31.8%), with ~7% \u0026lt;BDT 20,000. Educational attainment included 43.7% bachelor’s and 36.9% postgraduate degrees, with most working in inpatient care (58.3%) or teaching roles (24.8%) (Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1. Socio-demographic and socio-economic characteristics of study participants (n=721)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22-42 years (young)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e77.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43-63 years (adult)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e≥64 years (old)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eType of healthcare workers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNurse group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedical Officer and equivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eProfessor and equivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eMonthly expenditure in BDT\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;20000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20000-35000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35000-50000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;50000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePost-graduation (ongoing)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePost-graduation (completed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eWorking places\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIndoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOutdoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e08.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTeaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLaboratory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e03.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmergency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e01.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOthers (various duties and administration)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e02.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAMS awareness was limited (43%), with AMS committees present in 14% of facilities and 12% were of aware of implementation plans; while 17% reported AMS discussions in monthly quality meetings and 4% noted regular AMS review meetings. Only 11% had received AMS training (7% one‑day; 4% three‑day), 18% reported facility standard treatment guidelines, and 12% said management issues C/S‑based therapy alerts. Despite 71% reporting a microbiology department and 66% access to C/S testing, only 26% advised C/S when indicated, 15% received antibiograms, and targeted therapy was reported by 6% versus 77% empirical use (17% unsure). Exposure to AMS messaging reached 43% via posters, trainings, emails, awareness‑week events, or NGO activities; narrow‑spectrum use was observed by 8% versus 72% broad‑spectrum (20% unsure). Most respondents endorsed harms from antibiotic misuse (69%) and believed rational use with strong IPC reduces AMR (67%); only 7% required prior approval for reserve antibiotics (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2. AMS related knowledge, attitude and perception including relevant resources (n=721)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eFamiliar with the term AMS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAvailability of AMS committee \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eMonthly AMS meeting held\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e04.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAMS implementation plan developed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAMS discussed in regular monthly meeting\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAvailability of clinical guidelines or standard treatment guidelines (STG)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAvailability of \u0026nbsp; \u0026nbsp; microbiology department in the facility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAvailability of \u0026nbsp; \u0026nbsp; culture and sensitivity (C/S) test \u0026nbsp;in the \u0026nbsp;facility\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e479\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e66.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e05.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAdvice \u0026nbsp;C/S whenever indicated\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eModify antibiotic following C/S report\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePreparation and sharing of antibiogram by the \u0026nbsp;facility\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eStart empirical therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e552\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e76.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e05.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAMS training received\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e88.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eDuration of AMS training\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOne day\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e06.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eThree days\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e04.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e88.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;AMS awareness communicated through poster, emails, training or by NGOs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eManagement alert to modify antibiotic therapy based on C/S results\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e445\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eUse of broad spectrum antibiotics over narrow spectrum\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e08.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eMisuse of antibiotics can affect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePatients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFamily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e02.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e496\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEntire community\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e06.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e02.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eRational use of antibiotics and practice of IPC can reduce AMR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePrior approval is needed to prescribe reserve group antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e06.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eWe also analyzed the attitude and perception of care providers on AMS practice objectively. Around 60% perceived antibiotic overuse in their facilities, and 69% agreed AMR warrants focused attention. Only 12% reported access to trained infectious disease physicians, while 45% said they educate patients and families on rational antibiotic use. Over 20% perceived patient demand for stronger antibiotics, 12% felt colleague pressure toward broad‑spectrum agents, and 21% cited pressure from pharmaceutical companies (Table 3). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Attitude and perception of care providers on AMS practices (n=721)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResponse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAntibiotics are overused at our healthcare facility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrong disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e03.3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAMR is a problem at our healthcare facility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e08.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrong disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e09.4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eTrained infectious diseases physicians are available at our healthcare facility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e04.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e08.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrong disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e04.7\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePatients and their family members are educated on rational use of antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e09.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrong disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e02.6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePatients or their family members demand higher antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e05.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrong disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e08.3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePressure from seniors or colleagues on prescribing antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e04.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e07.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrong disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePharmaceutical companies influence my decision on prescribing antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e05.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrong disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAge, gender, and education were significantly associated with AMS KAP. Older and adult respondents were more familiar with AMS than younger peers (P\u0026lt;0.001), with the oldest group most frequently identifying AMS committees (31%). Modification of antibiotics following C/S increased with age, from 22% in the young group to 27% in adults and 54% in older respondents (P\u0026lt;0.001). Recognition of the role of antibiograms was highest in older respondents (31%) and lowest in adults (10%) (P\u0026lt;0.006). Overall, 43% had received communication on AMS importance, with higher engagement among young and old groups compared to adults (39%) (P\u0026lt;0.039).\u003c/p\u003e\n\u003cp\u003eMale respondents demonstrated higher AMS familiarity and practice indicators than females: familiarity 49% vs 38% (P\u0026lt;0.002), C/S recommendation 37% vs 16% and modification based on C/S 34% vs 14% (both P\u0026lt;0.001), and antibiogram reporting 18% vs 14% (P\u0026lt;0.006). Empirical therapy reporting was higher among males (90%) than females (60%), with 29% of females (predominantly nurses) were unsure of the term, indicating a pronounced sex‑based knowledge gap (P\u0026lt;0.001). AMS training was more common in males (15%) than females (8%) (P\u0026lt;0.002); males more often reported AMS communications (52%) yet favored broad‑spectrum over narrow‑spectrum agents (60%) (P\u0026lt;0.001). Approval requirements for reserve antibiotics were more frequently reported by males (12% vs 3%), though unfamiliarity with the process remained substantial (26% of males; 37% of females; P\u0026lt;0.001). Postgraduates and postgraduate trainees outperformed graduates in familiarity with AMS, awareness of teams/committees and implementation plans, and recognition of AMS importance (all P\u0026lt;0.001). Postgraduate doctors more frequently recommended C/S (42%) and modified therapy accordingly (38%) than counterparts (P\u0026lt;0.001); postgraduate trainees more often reported guideline/STG availability (27%) than graduates (P\u0026lt;0.001). Empirical therapy reporting was lower among bachelor‑level nurses (61%) than others (89% and 88%) (P\u0026lt;0.001), while seniors used broad‑spectrum antibiotics more than juniors (P\u0026lt;0.001) (Table 4). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4. Association between socio-demographic factors and KAP on AMS (n=721)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eP value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eAre you familiar with the term AMS?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon’t know (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYoung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e214 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e342 (61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e89 (58.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOld\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e09 (69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e04 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eIs there any AMS committee/teams?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYoung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e80 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e242 (43.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e234 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20 (13.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e79 (52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53 (34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOld\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e04 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e08 (61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e01 (07.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDo you modify antibiotics following C/S report?\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYoung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e120 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e378 (68.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41 (27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84 (55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOld\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e07 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e04 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e02 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDoes your facility prepare and share antibiogram?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYoung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e221 (39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e242 (43.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (09.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e81 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOld\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e04 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e07 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e02 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDoes your management alert about C/S results to modify antibiotic therapy?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYoung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68(12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e345 (62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e143 (25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93 (61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43 (28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOld\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e05 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e07 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e01 (07.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eHave you been communicated through posters, emails or NGOs on importance of AMS?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYoung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e240 (43.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e251 (45.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59 (38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e83 (54.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (06.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOld\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e09 (69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e04 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e00 (00.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDo you need prior approval before prescribing \u0026nbsp;reserve group antibiotics?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYoung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35 (06.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e349 (62.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e172 (30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (07.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e82 (53.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58 (38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOld\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e03 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e08 (61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e02 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eAre you familiar with the term AMS?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e164 (49.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e168 (50.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e148 (38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e241 (62.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDoes your facility conduct monthly AMS meeting?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (03.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e248 (74.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19 (04.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e219 (56.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e151 (38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDo you suggest for C/S whenever indicated?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e123 (37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e209 (63.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e326 (83.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDo you modify antibiotics following C/S report?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e114 (34.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e191 (57.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27 (08.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e275 (70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDoes your facility prepare and share antibiogram?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e157 (47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e117 (35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e152 (39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e183 (47.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDo you start impirical therapy?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e299 (90.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18 (05.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (04.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e253 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (06.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e112 (28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDid you receive any training on AMS?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50 (15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e282 (84.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30 (07.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e359 (92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDoes your management alert you to modify antibiotic therapy based on C/S results?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e203 (61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e66 (19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26 (06.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e242 (62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e121 (31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eHave you been communicated through posters, emails or NGOs on importance of AMS?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e173 (52.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e130 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29 (08.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e135 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e208 (53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDo you use broad spectrum antibiotics over narrow spectrum?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e198 (59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e77 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e114 (29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e99 (25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e176 (45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDo you think rational use of antibiotics and IPC can reduce AMR?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e254 (76.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62 (18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16 (04.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e227 (58.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e89 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e73 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDo you need prior approval before prescribing reserve group antibiotics?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e206 (62.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 (02.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e233 (59.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e145 (37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eAre you familiar with the term AMS?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e265 (84.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e178 (66.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e88 (33.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDoes your facility conducts monthly AMS meeting?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (04.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e165 (52.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e136 (43.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e03 (02.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e105 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (05.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e197 (74.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54 (20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eIs there any AMS committee or teams in your facility?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40 (12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e131 (41.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e144 (45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e69 (49.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44 (16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e147 (55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e75 (28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eIs there any AMS implementation plan in your facility?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e114 (36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e168 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41 (29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e112 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e116 (43.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDoes your facility discuss AMS in regular monthly meeting?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e66 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e129 (41.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e120 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (09.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e72 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55 (39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e156 (58.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e67 (25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eIs there any standard treatment guidelines available in your facility?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e160 (50.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e117 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38 (27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65 (46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37 (26.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53 (19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e150 (56.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63 (23.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDo you suggest for C/S whenever indicated?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e265 (84.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25 (17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e115 (82.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e111 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e155 (58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDo you modify antibiotics following C/S results?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e219 (69.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e115 (82.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e05 (03.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e102 (38.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e132 (49.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDoes your facility prepare and share antibiogram?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e102 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e165 (52.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26 (18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e149 (56.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e79 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDo you start empirical therapy?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e193 (61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20 (06.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e102 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e124 (88.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e01 (00.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e235 (88.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e07 (02.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (09.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDid you receive any training on AMS?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (06.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e294 (93.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (08.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e128 (91.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47 (17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e219 (82.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDoes your management alert you to modify antibiotic therapy based on C/S results?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18 (05.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e193 (61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e104 (33.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25 (17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e91 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e161 (60.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eHave you been communicated through posters, emails or NGOs on importance of AMS?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e109 (34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e166 (52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40 (12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e131 (49.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e114 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (07.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDo you use broad spectrum antibiotics over narrow spectrum?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e150 (47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e129 (41.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e139 (99.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e01 (00.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e00 (00.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e227 (85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (09.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (05.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDo you think rational use of antibiotics and IPC can reduce AMR?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e173 (54.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e72 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG ongoing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e99 (70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e05 (03.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e209 (78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (05.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eN.B. MO: Medical Officer, PG: Postgraduation, NGO: Non-government organization, IPC: Infection prevention and control, C/S: Culture and sensitivity\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe knowledge, attitudes, and perceptions (KAP) of healthcare providers towards antimicrobial stewardship (AMS) are strongly influenced by demographic and professional characteristics, including age, education, and professional engagement. In our study, only 43% of providers were familiar with the term AMS, leaving nearly 57% were unfamiliar. This level of familiarity is substantially lower than that reported in a multi-country survey across Latin America, where only 23% of healthcare providers reported unfamiliarity with AMS [30]. This discrepancy highlights important regional variations in awareness that warrant context-specific strategies.\u003c/p\u003e\n\u003cp\u003eEncouragingly, our study found that 43% of respondents received communication regarding antimicrobial resistance (AMR) and stewardship through posters, emails, training sessions, and campaigns organized by government and non-governmental agencies including globally recognized initiatives such as World Antimicrobial Awareness Week (WAAW). Similar modes of communication have been cited as effective tools in promoting AMS awareness in other settings, but their limited reach in our cohort suggests that existing outreach strategies may not be systematically adopted at the facility level.\u003c/p\u003e\n\u003cp\u003eIn terms of perception, a majority of respondents (68%) recognized that misuse of antibiotics, whether through overuse, underuse, irrational prescribing, or incomplete treatment increases morbidity, mortality, healthcare costs, and contributes directly to AMR. This aligns with findings from other international studies emphasizing the well-established link between irrational antibiotic use and antimicrobial resistance [30]. Two key pathways to preventing AMR have been consistently identified: the rational use of antimicrobials through AMS interventions and strict adherence to IPC measures. In our study, 67% of respondents acknowledged this, comparable to findings from Indian research reporting similar perceptions among healthcare professionals [31]. Nevertheless, a concerning 12% and 21% of participants either did not know about or did not believe in the impact of IPC compliance and rational antibiotic use, respectively. These gaps likely reflect underlying inadequacies in both access to accurate information and dissemination of standard treatment guidelines (STGs). Indeed, we found that only 18% of respondents reported access to STGs, a figure substantially lower than the 30-40% reported in Latin American countries [30]. This finding underscores the critical importance of developing and consistently implementing context-appropriate STGs for guiding therapy.\u003c/p\u003e\n\u003cp\u003eBeyond knowledge and perceptions, major barriers were identified in clinical practice. Despite the presence of microbiology departments (71%) and C/S facilities (66%) in respondents\u0026rsquo; institutions, only 26% routinely requested C/S testing and just 23% modified antibiotic regimens based on results. Furthermore, only 15.5% of laboratories prepared and shared antibiograms, a practice crucial for surveillance of local resistance patterns. This limited utilization contrasts sharply with recommendations from global stewardship frameworks, which emphasize the indispensability of antibiograms for promoting targeted rather than empirical therapy. The inadequate laboratory engagement observed in our study mirrors findings from other LMICs, where lack of systemic support for AMS program infrastructure restricts translation of knowledge into practice [32].\u003c/p\u003e\n\u003cp\u003eInstitutional support for AMS was also found to be weak. Only 14% of facilities reported having an AMS committee, 12% had an implementation plan, and 17% discussed AMS activities in regular quality improvement meetings. Similarly, low proportions of respondents reported training opportunities (11%) and less managerial support on modifying therapy based on C/S results (12%). Collectively, these indicators reflect significant deficiencies in system-level commitment to AMS. Studies from other resource-limited settings have also documented such gaps, reinforcing the notion that without structured programs, AMS implementation remains fragmented and highly inconsistent [33].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe challenge of empirical therapy emerged prominently, as only 6% of respondents reported practicing targeted therapy. This finding is consistent with global observations of high empirical prescribing rates in similar settings, with validation from studies across South Asia that similarly emphasize over-reliance on empirical regimens [9,34]. Inadequate uptake of culture-based prescribing highlights the need for stronger policy enforcement and education to improve diagnostic stewardship.\u003c/p\u003e\n\u003cp\u003eAnother critical issue identified was antibiotic prescribing trends. More than 60% of respondents acknowledged frequent use of broad-spectrum antibiotics and recognized AMR as a pressing problem in their facilities. This self-reported trend mirrors results from the national point prevalence survey (PPS) in Bangladesh, which documented that over 64% of patients received antibiotics from the WHO \u0026ldquo;Watch\u0026rdquo; group, predominantly broad-spectrum agents [35]. These patterns were reinforced in our study, reflecting a persistent trend even when healthcare providers are cognizant of the risks associated with broad-spectrum use. The drivers of excessive and often inappropriate prescribing included patient demanded (21%), influence from pharmaceutical companies (21%), and pressure from senior colleagues (12%). These factors are in line with reports from India and other LMICs, where social and professional pressures significantly shape physicians\u0026rsquo; antibiotic choices despite the availability of guidelines [36].\u003c/p\u003e\n\u003cp\u003eFinally, our analysis identified demographic factors such as age, gender, and education level as being significantly associated with KAP towards AMS. These associations have been corroborated in previous international studies, which suggest that targeted educational interventions tailored to specific sub-groups of healthcare workers may be more impactful than generalized campaigns [21,30,37].\u003c/p\u003e\n\u003cp\u003eOverall, our findings highlight critical gaps across awareness, practice, system-level support, and prescribing behavior. They resonate with challenges widely reported in other LMIC settings, but also point to context-specific solutions that prioritize expanding access to STGs, strengthening laboratory networks, ensuring facility-level stewardship committees, and addressing the socio-professional drivers of prescribing behavior.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 Limitation and strength\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRepresentativeness of the study is limited due to reliance on a convenience sample recruited via the IPC Alliance BD network and personal contacts, which may introduce selection bias and restrict external validity. Sub-national facilities were underrepresented among respondents, further constraining broadness across care levels and regions. Inclusion of both technical and non-technical staff, and prescribers and non-prescribers, raises the possibility of measurement and reporting biases (e.g., social desirability and underreporting of external pressures), which could affect estimates of determinants such as peer or pharmaceutical influence. The survey leveraged a large sample from diverse geographic areas and included participants from both public and private facilities, enhancing the breadth and contextual relevance of the findings. Inclusion of both prescribers and non-prescribers provided a comprehensive perspective on AMS knowledge, attitudes, and practices across professional roles, aligning with best-practice guidance to capture system-level determinants. Moreover, the patterns observed are consistent with prior literature on AMS/AMR KAP, supporting the credibility and triangulation of the results across settings.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study identified substantive gaps in knowledge, attitudes, practices, and overall perceptions related to antimicrobial stewardship (AMS), indicating priority needs across provider behavior, laboratory capacity, and managerial coordination. These findings can directly inform the design, scaling, and strengthening of AMS in Bangladesh. Emphasis should be placed on strengthening antimicrobial stewardship through the following priorities: enhancing provider and community awareness; expanding access to laboratory diagnostics and evidence-based treatment services; reinforcing the laboratory network and promoting routine use of antibiograms; improving physicians\u0026rsquo; prescribing practices; and ensuring strong managerial engagement to coordinate, monitor, and sustain AMS implementation. Collectively, a coordinated, multisectoral approach that integrates education, diagnostics, guideline-driven prescribing, and leadership accountability is essential to translate identified gaps into measurable gains in rational antimicrobial use and AMR mitigation.\u0026nbsp;\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eMd. Akram Hossain, Faisal Chowdhury, Ayesha Ahmed Khan, Md. Abu Sayem\u003c/p\u003e\n\u003cp\u003eInvestigation: Md. Akram Hossain, Md. Abu Sayem, Tanveer Ahmed, Kakali Halder, Sabrina Monsur, Musabbir Rahaman, Ummey Shahnaz Parvin, Mahbub Ul Alam, Md. Faysal Bin Salah, S.M. Selimuzzaman, Fahmida Khanam, Pompy Dey, Sourav Nath, Md. Muid Sakib, Zahin Zeima\u003c/p\u003e\n\u003cp\u003eMethodology, Statistical Analysis, Validation:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eMd. Abu Sayem, Md. Abdus Salam, Akram Hossain, Ayesha Ahmed Khan, Md. Faisal, Abu Sadat Mohammad Nurunnabi\u003c/p\u003e\n\u003cp\u003eWriting - Original draft preparation: Md. Abu Sayem, Faisal Chowdhury\u003c/p\u003e\n\u003cp\u003eWriting - Review and Editing\u003cem\u003e:\u003c/em\u003e Md. Abdus Salam, Md. Abu Sayem, Md. Akram Hossain\u003c/p\u003e\n\u003cp\u003eAll authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding information\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e There was no funding source for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003eWe are grateful to our survey participants and hospital authorities for providing their support, valuable time and information.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003eData and data file are available with corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChris Dall. 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JAC Antimicrob Resist. 2022;4(1):dlac012. https://doi.org/10.1093/jacamr/dlac012\u003c/li\u003e\n\u003cli\u003eMölstad S, Löfmark S, Carlin K, Erntell M, Aspevall O, Blad L, et al. Lessons learnt during 20 years of the Swedish strategic programme against antibiotic resistance. Bull World Health Organ. 2017;95(11):764-773. https://doi.org/10.2471/BLT.16.184374\u003c/li\u003e\n\u003cli\u003eDavis S, Verheyden C, Cooper M, Desai D. Navigating the New Antimicrobial Stewardship Regulations. Hosp Pharm. 2017;52(8):527-531. https://doi.org/10.1177/0018578717721541\u003c/li\u003e\n\u003cli\u003eAshiru-Oredope D, Sharland M, Charani E, McNulty C, Cooke J; ARHAI Antimicrobial Stewardship Group. Improving the quality of antibiotic prescribing in the NHS by developing a new Antimicrobial Stewardship Programme: Start Smart--Then Focus. 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The Lancet Regional Health-Western Pacific. 2025;60:101620. https://doi.org/10.1016/j.lanwpc.2025.101620\u003c/li\u003e\n\u003cli\u003eAlshehri AA, Khawagi WY. Knowledge, Awareness, and Perceptions Towards Antibiotic Use, Resistance, and Antimicrobial Stewardship Among Final-Year Medical and Pharmacy Students in Saudi Arabia. Antibiotics (Basel). 2025;14(2):116. https://doi.org/10.3390/antibiotics14020116\u003c/li\u003e\n\u003cli\u003eFabre V, Cosgrove SE, Lessa FC, Patel TS, Reyes-Morales G, Aleman WR, et al. Knowledge, attitudes and perceptions of Latin American healthcare workers relating to antibiotic stewardship and antibiotic use: a cross-sectional multi-country study. Antimicrob Resist Infect Control. 2024;13(1):47. https://doi.org/10.1186/s13756-024-01400-w\u003c/li\u003e\n\u003cli\u003eLongkumer I, William A, Madan M. Trend of \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e antimicrobial susceptibility pattern from a rural North Indian healthcare setting. Discov Public Health\u003cstrong\u003e. \u003c/strong\u003e2025;22:501. https://doi.org/10.1186/s12982-025-00903-0\u003c/li\u003e\n\u003cli\u003eChizimu JY, Mudenda S, Yamba K, Lukwesa C, Chanda R, Nakazwe R, et al. Antimicrobial stewardship situation analysis in selected hospitals in Zambia: findings and implications from a national survey. Front Public Health. 2024;12:1367703. https://doi.org/10.3389/fpubh.2024\u003c/li\u003e\n\u003cli\u003eBarbosa de Lima AC, Buabeng KO, Sakyi M, Chadwala HM, Devereaux N, Mitambo C, et al. Bridging the Capacity Building Gap for Antimicrobial Stewardship Implementation: Evidence from Virtual Communities of Practice in Kenya, Ghana, and Malawi. Antibiotics. 2025;14(8):794. https://doi.org/10.3390/antibiotics14080794\u003c/li\u003e\n\u003cli\u003eMarquet K, Liesenborgs A, Bergs J, Vleugels A, Claes N. Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis. Crit Care. 2015;19(1):63. https://doi.org/10.1186/s13054-015-0795-y\u003c/li\u003e\n\u003cli\u003eRashid MM, Akhtar Z, Chowdhury S, Islam MA, Parveen S, Ghosh PK, et al. Pattern of antibiotic use among hospitalized patients according to WHO access, watch, reserve (AWaRe) classification: Findings from a point prevalence survey in Bangladesh. Antibiotics. 2022;11(6):810. https://doi.org/10.3390/antibiotics11060810\u003c/li\u003e\n\u003cli\u003eReali S, Kwang YC, Cho JG, Alffenaar JW, Aslani P. Factors influencing physicians' antimicrobial prescribing decisions: A systematic review of qualitative studies. Br J Clin Pharmacol. 2025;91(5):1330-1351. https://doi.org/10.1002/bcp.70011\u003c/li\u003e\n\u003cli\u003eRaihan MA, Islam MS, Islam S, Islam AFMM, Ahmed KT, Ahmed T, et al. Knowledge, attitudes, and practices regarding antibiotic use in Bangladesh: Findings from a cross-sectional study. PLOS ONE.2024;19(2): e0297653. https://doi.org/10.1371/journal.pone.0297653\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Antimicrobial stewardship, Antibiotic use, Healthcare workers, Knowledge, attitudes, perceptions, Bangladesh","lastPublishedDoi":"10.21203/rs.3.rs-7726756/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7726756/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAntimicrobial resistance (AMR) disproportionately affects low and middle income countries (LMICs) including Bangladesh, driven by poorly implemented infection prevention and control (IPC) and misuse of antimicrobials. Robust Antimicrobial Stewardship (AMS) programs mitigate this risk by optimizing prescribing to best-practice standards. This study aimed to assess healthcare workers\u0026rsquo; (HCWs) knowledge, attitude and perception (KAP) toward AMS.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e An online questionnaire was shared via IPC Alliance BD to different health-related institutes and hospitals, inviting voluntary and anonymous participation of HCWs on KAP between January to March 2025.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 721 participants from 171 hospitals and institutes (78 public and 93 private), comprising 29% medical officers or equivalent, 29% nurses, 28% professors or equivalent and 14% administrative staff and other roles were enrolled. The average age was 36 years, and females accounted for 54% of respondents. Overall, 43% of respondents were familiar with the term AMS, reached through various sources. Only 11% received AMS training, and 18% had access to standard treatment guidelines. Despite 66% reporting availability of culture and sensitivity (C/S) testing, only 26% routinely recommended C/S and 15% shared an antibiogram. Empirical therapy predominated (\u0026gt;\u0026thinsp;94%), with a 60% preference for broad-spectrum agents. However, 67% believed rational use and proper IPC can reduce AMR. Knowledge, attitudes, and perceptions varied significantly by age, gender, and education (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eAntimicrobial resistance in Bangladesh necessitates strengthened laboratory capacity, expanded public awareness, and improved healthcare worker\u0026rsquo;s KAP via structured training and continuous monitoring, with robust antimicrobial stewardship as the operational benchmark.\u003c/p\u003e","manuscriptTitle":"Knowledge, Attitudes and Perceptions of Healthcare Workers on Antimicrobial Stewardship and Antibiotic Use: A Nationwide Multi-Center Study in Bangladesh","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 02:23:13","doi":"10.21203/rs.3.rs-7726756/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-21T17:03:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-21T01:59:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-13T08:50:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122975872200826373036150191409991710486","date":"2025-10-12T03:39:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81448326942330828656736103309758032443","date":"2025-10-08T12:29:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"146547362544590643234677735736370092086","date":"2025-10-08T04:14:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-30T12:39:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-30T10:02:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-30T05:15:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-09-30T05:11:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5981c12a-3ced-424e-a5a3-8a1f90800f97","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T15:59:15+00:00","versionOfRecord":{"articleIdentity":"rs-7726756","link":"https://doi.org/10.1186/s12982-025-01107-2","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2025-11-24 15:56:50","publishedOnDateReadable":"November 24th, 2025"},"versionCreatedAt":"2025-10-15 02:23:13","video":"","vorDoi":"10.1186/s12982-025-01107-2","vorDoiUrl":"https://doi.org/10.1186/s12982-025-01107-2","workflowStages":[]},"version":"v1","identity":"rs-7726756","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7726756","identity":"rs-7726756","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}