Bacterial culture practices and views on antimicrobial resistance among hospital physicians in Africa and Asia: ACORN2 KAP survey

Background To inform training strategies for the ACORN2 (“A Clinically Oriented antimicrobial Resistance surveillance Network”) project, a knowledge-attitudes-practices (KAP) survey was conducted among physicians to understand bacterial culture practices and views on antimicrobial resistance (AMR), diagnostic stewardship and surveillance. Methods A cross-sectional, self-administered, structured questionnaire survey, was done in 19 hospitals in Cambodia, Indonesia, Laos, Nepal, Vietnam (Asia) and Ghana, Kenya, Malawi, Nigeria (Africa) from Oct-2022 to Apr-2023. There were 586 respondents, 52% from sites in Africa and 48% from sites in Asia. Results Physicians in both regions acknowledged the problem of AMR in their hospital and country, the importance of diagnostic stewardship and AMR surveillance. More respondents from sites in Asia, compared to Africa, (78% vs 44%) had received training on AMR, and more hospitals in Asia (84% vs. 51%) had guidelines for culture specimen collection. Physician defined suspected sepsis or septic shock was the most frequent reason given for ordering a blood culture specimen in sites in both regions (28% Africa, 19% Asia). As part of diagnostic work up, most respondents requested microbiology testing for most or all patients with suspected bacterial infections (71% Africa, 85% Asia), sepsis/bloodstream infections (77% Africa, 97% Asia), bacterial pneumonia (38% Africa, 75% Asia), urinary tract infections (77% Africa, 89% Asia) and when starting parenteral antibiotics (38% Africa, 75% Asia). Conclusions Despite good awareness and knowledge of AMR at ACORN surveillance sites, heterogeneity in practices between sites and regions indicated the need for context-specific, tailored training related to AMR surveillance and diagnostic stewardship.