To identify behavioral factors explored in the literature and the theoretical frameworks used to understand antimicrobial prescribing behaviors of ICU physicians.

Scoping review following the JBI methodology.

Studies conducted in intensive care units (ICUs) across various healthcare systems.

Physicians working in ICUs; studies involving other healthcare professionals or aggregating data from multiple specialties were excluded.

Not applicable.

From 995 records identified through PubMed, Embase, Scopus, CINAHL, and Web of Science, 18 studies met inclusion criteria. Fourteen were cross-sectional surveys and four used qualitative semi-structured interviews. Knowledge about antimicrobial use and its role in resistance was generally adequate. Attitudes reflected that beliefs, clinical uncertainty, and contextual factors influenced prescribing behaviors. Reported practices highlighted the role of adherence to institutional protocols and guidelines. Despite the behavioral focus, most studies lacked explicit use of theoretical frameworks to guide data collection or interpretation.

Antimicrobial prescribing in ICUs is influenced by behavioral determinants that are not consistently evaluated using theoretical models. Future research on Knowledge, Attitudes, and Practices (KAP) should integrate behavioral science frameworks to enhance understanding and enable better design of stewardship interventions.

Efforts to address overuse of antibiotics for RTIs are important to limit antimicrobial resistance. Leaflets used during GP consultations can empower patients to self-manage respiratory infections (RTIs) and support a reduction in unnecessary antibiotic prescribing.

This study aimed to assess the feasibility and acceptability of a Treat Your RTI (TY-RTI) patient leaflet for GP consultations in Ireland.

A single-arm mixed-methods feasibility study was conducted. Six GPs in daytime practice and three GPs in out-of-hours (OOH) services were recruited to use the TY-RTI leaflet during routine RTI consultations where an immediate antibiotic was not deemed necessary. GPs and patients completed questionnaires to assess the feasibility and usefulness of the leaflet during the consultation. Ethical approval was obtained.

The TY-RTI patient leaflet was used by GPs in 201 RTI consultations (57 in OOH, 28%), and 84 (42%) patients/parents completed the questionnaire (9/84 in OOH, 11%). For over 90% (182/201) of consultations, GPs reported the leaflet was useful, supported communication, safety-netting, and did not increase consultation time. All patients/parents found the leaflet easy to read and useful. They reported the leaflet gave them confidence to self-manage RTIs without antibiotics (88%, 74/84), and it changed their views of the need for antibiotics (81%, 68/84).

This study demonstrates the feasibility and acceptability of the TY-RTI leaflet for GPs and patients, supporting its wider implementation. The leaflet supports improved communication and safety netting in the consultation and empowers patients in the self-management of RTIs, with potential to reduce patients’ antibiotic-seeking behavior.

To evaluate physician engagement with an antimicrobial stewardship program (ASP) at a tertiary hospital and identify areas for improvement in the delivery of stewardship interventions.

Cross-sectional survey study.

A 1200-bed tertiary care public hospital in Portugal.

Physicians with antibiotic prescribing privileges in inpatient settings. All physicians with active institutional e-mail addresses were invited to participate.

An anonymous web-based questionnaire was administered between June and December 2024. The survey addressed six domains: (1) antibiotic knowledge; (2) awareness and use of local prescribing protocols; (3) access to antimicrobial use and resistance reports; (4) awareness of antibiotic restriction policies; (5) use of informal consultations with the stewardship team; and (6) participation in scheduled multidisciplinary case discussions.

A total of 154 prescribing physicians responded (response rate: 10%), including specialists (75.3%) and residents (24.0%). Most respondents were aware of institutional protocols (78.6%), but 66.9% reported rarely or never consulting them, citing accessibility and reliance on personal knowledge as key barriers. Participation in case discussions was limited (25.3%) but viewed as highly useful. Awareness of restrictive antibiotic policies was low; however, 69.5% indicated that these policies influenced their prescribing behavior. Respondents expressed strong interest in regular feedback on antimicrobial use and resistance trends.

Key areas for improvement in ASP implementation include enhancing access to protocols, expanding case-based discussions, clarifying communication around restrictions, and establishing regular feedback mechanisms. These findings may inform efforts to align ASP strategies with clinical realities in similar hospital settings.

To describe an outbreak of Burkholderia cepacia complex at a tertiary care hospital in Karachi, Pakistan, highlighting contributing factors, potential sources, and system-level gaps identified during the investigation.

Outbreak investigation.

A 655-bed tertiary care teaching hospital in Karachi, Pakistan.

All individuals who had positive blood cultures by non-lactose fermenting, oxidase-positive, Gram-negative rods that could not be further characterized.

On September 26, 2020, the Department of Infection Prevention and Hospital Epidemiology (DIPHE) was notified of multiple positive blood cultures. An outbreak investigation was initiated, including chart reviews, laboratory analysis, environmental sampling, assessing central line insertion practices, and evaluating the manufacturing site. Clinical Laboratory Standards Institute (CLSI) guidelines were used for microbiological identification and susceptibility testing.

Thirty-five patients with positive cultures were identified between September 15 and October 22, 2020. While environmental sampling did not yield growth, significant breaches at the suppliers‘ facility were identified in chlorhexidine gluconate (CHG) storage and quality control. Although cultures of CHG were negative, the product’s withdrawal led to a marked decline in new cases. Moreover, while resources were unavailable for genomic testing, antimicrobial susceptibility patterns were similar in all the case strains, suggesting a common source.

This outbreak highlights the role of contaminated disinfectants in healthcare-associated infections. It also revealed systemic gaps in disinfectant quality control, storage facilities, and diagnostic capacity, delaying outbreak recognition and response. It is essential to strengthen regulatory oversight, implement standardized testing protocols, and enhance microbiological diagnostic infrastructure to lower the risk of similar outbreaks.