Physicians’ perspectives on antimicrobial resistance and rational antibiotic prescribing
Journal
American Journal of Infection Control
ISSN
1527-3296
Publisher
Elsevier BV
Date Issued
2026
Author(s)
Villaseñor-Echavarri, Rodrigo
Velez-Pintado, Mariana
Type
text::journal::journal article
Abstract
Background: Antimicrobial resistance poses a growing global threat. In real-world practice, antimicrobial prescribing is shaped by clinicians’ cognitive biases and perceptions of resistance risk, potentially driving unnecessary broad-spectrum antibiotic use and increased antimicrobial pressure. Methods: We conducted a questionnaire-based study among physicians to assess perceptions on antimicrobial resistance magnitude, determinants of prescription, and barriers to de-escalation. Clinician-estimated resistance rates were compared with observed data, and the main factors influencing antimicrobial prescription were analyzed. Results: 82 physicians were surveyed; 76% were attendings; 37% internal medicine, 30% pediatrics, and 11% infectious diseases (adult and pediatric). Clinicians consistently overestimated carbapenem-resistant (CR) Klebsiella pneumoniae and Escherichia coli, methicillin-resistant Staphylococcus aureus, and VRE (Holm-adjusted P < .001). Non-ID clinicians overestimated resistance rates compared with ID physicians (CR E coli 26.7% vs 8.8%, CR K pneumoniae 23.4% vs 10.0%, MRSA 35.6% vs 16.6%, and vancomycin-resistant Enterococcus spp 28.3% vs 12.2%, all P < .05). Conclusions: This study reveals a gap between perceived and observed resistance rates, indicating cognitive biases that favor broad empirical therapy and delayed de-escalation. Differences by specialty underscore the role of specialized training, while fear- and severity-driven decision-making reflects a defensive prescribing approach that may undermine antimicrobial stewardship efforts. ©The authors Copyright: © 2026 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc.
License
Acceso Restringido
How to cite
Villaseñor-Echavarri, R., & Velez-Pintado, M. (2026). Physicians’ perspectives on antimicrobial resistance and rational antibiotic prescribing. American Journal of Infection Control. https://doi.org/10.1016/j.ajic.2026.02.236