# Antimicrobial stewardship at a tertiary center in Portugal: insights from prescribers

## TL;DR

This study explores how doctors at a large hospital in Portugal engage with an antimicrobial stewardship program and identifies ways to improve it.

## Contribution

The study provides insights into physician engagement with antimicrobial stewardship and highlights actionable areas for program improvement.

## Key findings

- Most physicians were aware of protocols but rarely consulted them due to accessibility issues.
- Only 25.3% of physicians participated in case discussions, which they found highly useful.
- Regular feedback on antimicrobial use and resistance trends was strongly requested by respondents.

## Abstract

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.