Background: Antimicrobial use is very common in hospitalized children. An assessment of clinician�s prevailing\nknowledge and clinical approach to prescribing antimicrobials is helpful in order to develop the best strategies for\nsuccessful stewardship programs. The objectives of the study were to determine fundamental knowledge of\nprinciples, approach to antimicrobial use through the clinical vignettes and to identify perceived challenges in\ndecreasing antimicrobial use.\nMethods: A questionnaire was developed by subject matter experts and pretested to ensure validity. Using a\ncross-sectional prospective design, the questionnaire was completed anonymously by staff and trainee physicians\nat a single tertiary care pediatric hospital between late November 2011 and February 2012.\nResults: Of 159 eligible physicians, 86 (54.1%) responded, of which 77 (46 staff and 31 trainees) reported regularly\nprescribing antimicrobials. The majority of physicians had modest knowledge of factors that would increase risk of\nresistance however, less than 20% had correct knowledge of local resistance patterns for common bacteria. Almost\nhalf of physicians correctly answered the clinical vignettes. Over half of trainees and one third of staff relied most\non online manuals for information regarding antimicrobials to assist prescription decision-making. Overall, physicians\nperceived that discontinuing empiric antimicrobials was the most difficult to achieve to decrease antibiotic use.\nConclusions: Our results highlight several challenges that pediatric practioners face with respect to knowledge and\napproach to antimicrobial prescribing. Pediatric stewardship programs could in this setting focus on discontinuing\nantimicrobials appropriately and promoting local antibiograms in the proper clinical setting to decrease overall use\nof antimicrobials.
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