Knowledge, Attitudes, and Practices Regarding Asymptomatic Bacteriuria Among Healthcare Professionals

Background: Asymptomatic bacteriuria (ASB) is a driver of unnecessary antimicrobial use in hospitals. Despite recommendations against screening and treating most patients with ASB, inappropriate urine culture ordering and antibiotic prescribing remain common. This study assessed healthcare professionals’ knowledge, attitudes, and practices regarding ASB and identified behavioral determinants relevant to diagnostic and antimicrobial stewardship. Methods: A cross-sectional questionnaire-based survey was conducted among physicians, nurses, and microbiologists at a tertiary care hospital in India. A structured questionnaire that underwent expert face and content validation assessed knowledge, attitudes, perceived barriers, and profession-specific practices. Behavioral determinants were mapped using the Capability-Opportunity-Motivation Behavior (COM-B) framework. Data were analyzed descriptively. Results: A total of 515 healthcare professionals participated. Although 95% reported awareness of the distinction between urinary tract infection and ASB, and 89% reported knowing when bacteriuria should be treated, only 11% were aware of guideline recommendations. The overall mean knowledge score was 3.3/10. Among physicians, 62% reported treating ASB in all patients and 34% documented urine culture indications. Among nurses, 54% reported collecting urine from the collection bag, and 15.5% consistently performed hand hygiene before and after catheter insertion. Fear of poor patient outcomes if ASB remained untreated (69%), inadequate understanding of guideline recommendations (68%), and lack of time (62%) were the most frequently reported barriers; 99% supported diagnostic stewardship initiatives. Conclusions: Knowledge gaps and practice variation in ASB management are substantial across healthcare professionals. A coordinated multidisciplinary approach is needed to address these multifactorial barriers and improve stewardship.