Objectives: Antibiotic overuse is one of the main drivers of antimicrobial resistance (AMR), especially in low and middle-income countries. This study aimed to gain an understanding of perceptions, views, and practices regarding AMR, antibiotic prescribing, and stewardship (AMS) among hospital physicians in Jakarta, Indonesia. Design: cross-sectional, self-administered questionnaire-based survey, with descriptive statistics, exploratory factor analysis (EFA) to identify distinct underlying constructs in the dataset, and multivariable linear regression of factor scores to analyse physician subgroups. Setting: Six public and private general hospitals in Jakarta in 2019. Participants: 1007 of 1896 (53.1% response rate) antibiotic prescribing physicians. Results: EFA identified six latent factors (overall Crohnbach alpha=0.85): awareness of AMS activities; awareness of AMS purpose; views regarding rational antibiotic prescribing; confidence in antibiotic prescribing decisions; perception of AMR as a significant problem; and immediate actions to contain AMR. Physicians acknowledged the significance of AMR and contributing factors, rational antibiotic prescribing, and purpose and usefulness of AMS. However, this conflicted with reported suboptimal local hospital practices, such as room cleaning, hand hygiene and staff education, and views regarding antibiotic decision-making. These included insufficiently applying AMS principles and utilising microbiology, lack of confidence in prescribing decisions, and defensive prescribing due to pervasive diagnostic uncertainty, fear of patient deterioration or because patients insisted. Physicians factor scores differed across hospitals, departments, work experience and medical hierarchy. Conclusions: AMS implementation in Indonesian hospitals is challenged by institutional, contextual and diagnostic vulnerabilities, resulting in externalising AMR instead of recognising it as a local problem. Appropriate recognition of the contextual determinants of antibiotic prescribing decision-making will be critical to change physicians attitudes and develop context-specific AMS interventions

中文翻译：

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印度尼西亚雅加达医院医生对抗生素处方和管理的看法、观点和做法

目标：抗生素过度使用是抗菌素耐药性 (AMR) 的主要驱动因素之一，尤其是在低收入和中等收入国家。本研究旨在了解印度尼西亚雅加达医院医生对 AMR、抗生素处方和管理 (AMS) 的看法、观点和做法。设计：横断面、自我管理的基于问卷的调查，具有描述性统计、探索性因素分析 (EFA) 以识别数据集中不同的潜在结构，以及因素得分的多变量线性回归以分析医生亚组。设置：2019 年雅加达的 6 家公立和私立综合医院。参与者：1896 名（53.1% 响应率）抗生素处方医师中的 1007 名。结果：EFA 确定了六个潜在因素（总体克罗恩巴赫 alpha=0.85）：对 AMS 活动的认识；对 AMS 目的的认识；关于合理抗生素处方的看法；对抗生素处方决定的信心；将 AMR 视为一个重大问题；并立即采取行动遏制 AMR。医生们承认 AMR 的重要性和促成因素、合理的抗生素处方以及 AMS 的目的和有用性。然而，这与报告的次优当地医院做法相冲突，例如房间清洁、手部卫生和员工教育，以及对抗生素决策的看法。这些包括未充分应用 AMS 原则和利用微生物学，对处方决定缺乏信心，以及由于普遍的诊断不确定性、害怕患者恶化或因为患者坚持而进行防御性处方。医生因素得分因医院、科室、工作经验和医疗等级而异。结论：印度尼西亚医院的 AMS 实施受到制度、背景和诊断漏洞的挑战，导致 AMR 外部化而不是将其视为本地问题。正确认识抗生素处方决策的背景决定因素对于改变医生的态度和制定针对特定背景的 AMS 干预措施至关重要