Knowledge, attitudes and behaviour of Swiss healthcare workers on antibiotic use and resistance: a cross-sectional study

Healthcare workers (HCW) play a key role in prescribing antibiotics and preventing the spread of resistant pathogens in healthcare settings. This survey aimed to assess HCW knowledge and behaviour regarding antibiotic use and antimicrobial resistance (AMR). In November 2022, participants of the SURPRISE+ cohort - including HCW from 14 institutions in eastern Switzerland - were invited to complete a 141-item questionnaire on knowledge and attitudes regarding AMR, antibiotic prescribing habits and personal antibiotic use. Survey results were summarized and stratified by professional groups: physicians, nurses, paramedics and other professionals. Of the 3’514 HCW invited, 1’505 (43%) completed the survey. Of these, 10% were physicians, 45% nurses, 15% paramedics and 29% other professionals. The median age was 45 years (range 16–69) and 81% were women. Concern about AMR in Switzerland was expressed by 73.8% (1’111/1’505) of participants. However, only 37.9% (570/1’505) were concerned about AMR in their own healthcare institution. 64.4% (969/1’505) of respondents believed that too many antibiotics are prescribed in Switzerland, whereas only 24.6% (371/1’505) thought this was the case in their own institution. 13% (16/123) of the physicians believed that they prescribe antibiotics too often, while 43.1% (53/123) felt that their colleagues overprescribe. Only 43.2% (67/155) of the physicians and 9.4% (64/682) of the nurses believed that they play a key role in controlling AMR. A total of 56.1% (845/1’505) of participants, particularly physicians and nurses, expressed a desire for more information or training on AMR and antibiotic use. Regarding personal use of antibiotics, 18.2% (274/1’505) reported taking at least one antibiotic in the previous 12 months. Most participants (93.9%, 1’413/1’505) reported taking antibiotics strictly as prescribed. However, 11.6% (175/1’505) reported taking antibiotics without a prescription. HCWs in our cohort demonstrated a marked discrepancy between their self-assessment and their perceptions of others regarding antibiotic resistance and antibiotic overuse. The perception among HCWs that they play only a limited role in combating antimicrobial resistance is concerning. Our findings highlight the need for targeted educational interventions to enhance awareness and engagement in antimicrobial stewardship.