Knowledge, attitudes and perceptions of Latin American healthcare workers relating to antibiotic stewardship and antibiotic use: a cross-sectional multi-country study
Authors: Fabre Valeria , Cosgrove Sara E. , Lessa Fernanda C. , Patel Twisha S. , Reyes-Morales Guadalupe , Aleman Washington R. , Alvarez Andrea Alvarado , Aquiles Bowen , Arauz Ana B. , Arguello Facundo , Barberis Maria Fernanda , Barcan Laura , Bernachea Maria P. , Bernan Marisa L. , Buitrago Carlos , Del Carmen Bangher Maria , Castañeda Ximena , Colque Angel M. , Canton Alfredo , Contreras Rosa , Correa Silvia , Campero Gustavo Costilla , Espinola Lidia , Esquivel Clara , Ezcurra Cecilia , Falleroni Leandro A. , Fernandez Johana , Ferrari Sandra , Frassone Natalia , Cruz Carlos Garcia , Garzón Maria Isabel , Quintero Carlos H. Gomez , Gonzalez José A. , Guaymas Lucrecia , Guerrero-Toapanta Fausto , Lambert Sandra , Laplume Diego , Lazarte Paola R. , Lemir César G. , Lopez Angelica , Lopez Itzel L. , Maldonado Herberth , Martinez Guadalupe , Maurizi Diego M. , Melgar Mario , Mesplet Florencia , Pertuz Carlos Morales , Moreno Cristina , Moya Gabriela L. , Nuccetelli Yanina , Núñez Glendys , Osuna Carolina , Palacio Belén , Pellice Florencia , Raffo Carla , Choto Fanny Reino , Ricoy Gerardo , Rodriguez Viviana , Romero Federico , Romero Juan J. , Russo Maria Eugenia , Sadino Graciela , Sandoval Nancy , Silva Mirta G. , Urueña Alejandra M. , Reyes Ligia Vence , Videla Hugo , Valle Marisol , Perez Silvia Vera Amate , Vergara-Samur Hernan , Villamandos Silvina , Villarreal Olmedo , Viteri Alejandra , Warley Eduardo , Quiros Rodolfo E. 
Published: April 2024

Abstract
Background
The burden of antimicrobial resistance (AMR) in Latin America is high. Little is known about healthcare workers’ (HCWs) knowledge, attitudes, and perceptions of antimicrobial stewardship (AS), AMR, and antibiotic use (AU) in the region.

Methods
HCWs from 42 hospitals from 5 Latin American countries were invited to take an electronic, voluntary, anonymous survey regarding knowledge, attitudes, and perceptions of AS, AMR, and AU between March–April 2023.

Findings
Overall, 996 HCWs completed the survey (52% physicians, 32% nurses, 11% pharmacists, 3% microbiologists, and 2% “other”). More than 90% of respondents indicated optimizing AU was a priority at their healthcare facility (HCF), 69% stated the importance of AS was communicated at their HCF, and 23% were unfamiliar with the term “antibiotic stewardship”. Most (> 95%) respondents acknowledged that appropriate AU can reduce AMR; however, few thought AU (< 30%) or AMR (< 50%) were a problem in their HCF. Lack of access to antibiogram and to locally endorsed guidelines was reported by 51% and 34% of HCWs, respectively. Among prescribers, 53% did not consider non-physicians’ opinions to make antibiotic-related decisions, 22% reported not receiving education on how to select antibiotics based on culture results and 60% stated patients and families influence their antibiotic decisions.

Conclusions
Although HCWs perceived improving AU as a priority, they did not perceive AU or AMR as a problem in their HCF. AS opportunities include improved access to guidelines, access to AMR/AU data, teamwork, and education on AS for HCWs and patients and families.