Perceptions And Practices Regarding Antimicrobial De-Escalation In Tertiary Care Settings Of Medical, Dental And Nursing Colleges Of Rajasthan and Uttar Pradesh, India
DOI:
https://doi.org/10.64252/4w9brs17Keywords:
Antimicrobial, de – escalation, perception, practices, medical college, dental college, nursing collegeAbstract
Background: Antibiotic de-escalation (ADE) is a core strategy of antimicrobial stewardship programs (ASPs) intended to reduce unnecessary broad-spectrum antibiotic exposure and mitigate antimicrobial resistance (AMR). Understanding frontline health-care workers’ perceptions and practices is essential to design effective ASP interventions in tertiary care hospitals.
Objective: To assess perceptions, knowledge, and self-reported practices regarding antibiotic de-escalation among MBBS students & interns, nursing students, and paramedical staff across three tertiary care hospitals in India.
Methods: Cross-sectional survey of 250 participants (100 MBBS students/interns, 50 nursing students, 100 paramedical staff including nurses and technicians) from three tertiary hospitals. We used a 15-item 5-point Likert questionnaire assessing knowledge, attitudes, readiness, barriers, and self-reported practices around ADE. Data were summarized with descriptive statistics; group comparisons used χ², Kruskal-Wallis or ANOVA as appropriate and multivariable logistic regression to identify predictors of appropriate ADE practice.
Results: Overall awareness of ADE was high (78%), but only 46% reported consistent application of ADE in clinical practice. MBBS students/interns showed higher knowledge scores than nursing students and paramedical staff (mean knowledge score 4.1 ± 0.6 vs 3.6 ± 0.7 and 3.5 ± 0.8; p < 0.001). Major barriers included lack of timely microbiology results (72%), unclear institutional protocols (58%), and fear of clinical deterioration (53%). Participation in formal ASP training was the strongest predictor of reported ADE practice (adjusted OR 2.6; 95% CI 1.7–4.0).
Conclusion: Although awareness of ADE is substantial, consistent implementation is limited by system and knowledge barriers. Strengthening ASP training, improving diagnostic turnaround times, and clear local ADE protocols are recommended to improve ADE uptake in tertiary care settings.
