Knowledge on Antimicrobial Resistance and Stewardship in Undergraduate Nursing Students: A Cross-sectional study
Article Sidebar
Main Article Content
Abstract
Background: Antimicrobial resistance (AMR) is a global health threat, causing increased morbidity, mortality, and healthcare costs. Effective antimicrobial stewardship (AMS) is crucial to limit its spread. Nurses play a critical role in addressing AMR, but knowledge deficiency among undergraduate nursing students can hinder their preparedness for stewardship responsibilities. This study aims to determine the knowledge level of undergraduate nursing students about antibiotics, AMR, and AMS, addressing the challenge of knowledge deficiency among these students.
Methods: A cross-sectional study was conducted on 140 undergraduate nursing students, using a self-administered questionnaire to collect demographic data and knowledge about antibiotics, antimicrobial resistance, and antimicrobial stewardship. Statistical analyses were performed using SPSS version 20.0, with descriptive statistics providing an overview of participants' knowledge and chi-square tests investigating associations between factors like age, gender, semester, and residence with knowledge.
Results: Participants had the mean knowledge score of 7 ± 2.067, and none of the participants had adequate knowledge, 40.7% had moderately adequate knowledge, and 59.3% had inadequate knowledge. Semester of study was the only factor that had significant relations with knowledge on antimicrobial resistance and stewardship (p = 0.010).
Conclusion: The study reveals significant gaps in undergraduate nursing students' understanding of antibiotics, antimicrobial resistance, and stewardship, highlighting the need for comprehensive curricular reform and innovative educational strategies to prepare future nurses for addressing antimicrobial resistance and strengthening healthcare systems.
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
References
WHO. Antimicrobial resistance [Internet]. 2023 [cited 2025 Jun 14]. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
Naylor NR, Atun R, Zhu N, Kulasabanathan K, Silva S, Chatterjee A, et al. Estimating the burden of antimicrobial resistance: a systematic literature review. Antimicrob Resist Infect Control. 2018 Apr 25;7:58. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5918775/
Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health. 2015 Oct;109(7):309–18. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4768623/
de Kraker MEA, Stewardson AJ, Harbarth S. Will 10 Million People Die a Year due to Antimicrobial Resistance by 2050? PLoS Med. 2016 Nov;13(11):e1002184. Available from: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002184
Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet [Internet]. 2022 Feb 12;399(10325):629–55. Available from: https://doi.org/10.1016/S0140-6736(21)02724-0
Castro-Sanchez E, Moore LSP, Husson F, Holmes AH. What are the factors driving antimicrobial resistance? Perspectives from a public event in London, England. BMC Infect Dis. 2016 Sep 2;16(1):465. Available from: https://doi.org/10.1186/s12879-016-1810-x
Dyar OJ, Huttner B, Schouten J, Pulcini C, ESGAP (ESCMID Study Group for Antimicrobial stewardship). What is antimicrobial stewardship? Clin Microbiol Infect. 2017 Nov;23(11):793–8. Available from: https://doi.org/10.1016/j.cmi.2017.08.026
Carter EJ, Greendyke WG, Furuya EY, Srinivasan A, Shelley AN, Bothra A, et al. Exploring the nurses’ role in antibiotic stewardship: A multisite qualitative study of nurses and infection preventionists. Am J Infect Control. 2018 May;46(5):492–7. Available from: https://doi.org/10.1016/j.ajic.2017.12.016
Olans RN, Olans RD, DeMaria A. The Critical Role of the Staff Nurse in Antimicrobial Stewardship--Unrecognized, but Already There. Clin Infect Dis. 2016 Jan 1;62(1):84–9. Available from: https://doi.org/10.1093/cid/civ697
Teague E, Bezuidenhout S, Meyer JC, Godman B, Engler D. Knowledge and Perceptions of Final-Year Nursing Students Regarding Antimicrobials, Antimicrobial Resistance, and Antimicrobial Stewardship in South Africa: Findings and Implications to Reduce Resistance. Antibiotics (Basel). 2023 Dec 16;12(12). Available from: https://doi.org/10.3390/antibiotics12121742
Rabano-Blanco A, Dominguez-Martis EM, Mosteiro-Miguens DG, Freire-Garabal M, Novio S. Nursing students’ knowledge and awareness of antibiotic use, resistance and stewardship: A descriptive cross-sectional study. Antibiotics. 2019 Dec 1;8(4). Available from: https://doi.org/10.3390/antibiotics8040203
Al-Taani GM, Karasneh RA, Al-Azzam S, Bin Shaman M, Jirjees F, Al-Obaidi H, et al. Knowledge, Attitude, and Behavior about Antimicrobial Use and Resistance among Medical, Nursing and Pharmacy Students in Jordan: A Cross Sectional Study. Antibiotics. 2022 Nov 5;11(11).1559. Available from: https://doi.org/10.3390/antibiotics11111559
Varshney S, Karthika P, Ahmad S, Mehnaz S. Knowledge, Attitude and Practices Regarding Antimicrobial Resistance among Undergraduate Students. Indian J Community Health. 2024;36(4):556–64. Available from: https://doi.org/10.47203/IJCH.2024.v36i04.009
Rana S, Kaur KN, Narad P, Walia K, Saeed S, Chandra A, et al. Knowledge, attitudes and practices of antimicrobial resistance awareness among healthcare workers in India: a systematic review. Front Public Health. 2024 July 22;12:1433430. Available from: https://doi.org/10.3389/fpubh.2024.1433430
Chaudhary S, Singh AL. Impact of self-directed learning strategy, an innovative method in nursing undergraduates: Study protocol for a randomized controlled trial. PLoS One. 2025;20(7):e0325300. Available from: https://doi.org/10.1371/journal.pone.0325300
Jianvitayakij S, Niyomyart A, Junsawang C, Bualoy W, Butsing N, Monkong S, et al. Knowledge of antibiotics and antibiotic resistance, antibiotic use and eHealth literacy among nursing students in Thailand: a cross-sectional study. BMJ Open. 2024 Nov 9;14(11):e090956. Available from: https://doi.org/10.1136/bmjopen-2024-090956
Perez R, Hayes JE, Winters AR, Wrenn RH, Moehring RW. Antimicrobial stewardship knowledge, attitudes, and practices (KAP) among nurses. Antimicrobial Stewardship and Healthcare Epidemiology. 2024 Apr 18;4(1):e51. Available from: https://doi.org/10.1017/ash.2024.63
Akande-Sholabi W, Ajamu AT. Antimicrobial stewardship: Assessment of knowledge, awareness of antimicrobial resistance and appropriate antibiotic use among healthcare students in a Nigerian University. BMC Med Educ. 2021 Sep 10;21(488). Available from:
https://doi.org/10.1186/s12909-021-02912-4
Akbar Z, Alquwez N, Alsolais A, Thazha SK, Ahmad MD, Cruz JP. Knowledge about antibiotics and antibiotic resistance among health-related students in a Saudi University. J Infect Dev Ctries. 2021 Jul 31;15(7):925–33. Available from: https://doi.org/10.3855/jidc.12329
Hussain I, Yousaf N, Haider S, Jalil P, Saleem MU, Imran I, et al. Assessing knowledge and perception regarding antimicrobial stewardship and antimicrobial resistance in university students of Pakistan: Findings and implications. Antibiotics. 2021 Jul 16;10(7):866. Available from: https://doi.org/10.3390/antibiotics10070866
McEwen J, Burnett E. Antimicrobial stewardship and pre-registration student nurses: Evaluation of teaching. J Infect Prev. 2018 Mar 1;19(2):80–6. Available from: https://doi.org/10.1177/1757177417726156
Jackson IL, Akpan MR, Adebayo GO. Knowledge and perception of antimicrobial resistance and antimicrobial stewardship among healthcare students in Nigeria. Afr Health Sci. 2023 Dec 27;23(4):195–202. Available from: https://doi.org/10.4314/ahs.v23i4.22
Molsaeter A, Henni S, Opheim R, Hoye S, Borosund E. Antibiotic-savvy nursing students? Nursing students’ knowledge and self-assessed competence in antibiotic use and resistance. Sykepleien Forskning. 2023;18(93743)e-93743. Available from: https://doi.org/10.4220/Sykepleienf.2023.93743en
Bouchoucha SL, Kilpatrick M, Phillips NM, Hutchinson AF. Nursing students’ awareness and perceptions of nurses’ role in antimicrobial stewardship. Nurse Educ Pract. 2021 Mar;52:103036. Available from: https://doi.org/10.1016/j.nepr.2021.103036
De Vita E, Segala FV, Frallonardo L, Civile G, De Scisciolo D, Novara R, et al. Knowledge, Attitudes, and Practices toward Antimicrobial Resistance among Young Italian Nurses and Students: A Multicenter, Cross-Sectional Study. Ann Glob Health. 2024 Jul 22;90(1):46. Available from: https://doi.org/10.5334/aogh.4488
Yang C, Xie J, Chen Q, Yuan Q, Shang J, Wu H, et al. Knowledge, Attitude, and Practice About Antibiotic Use and Antimicrobial Resistance Among Nursing Students in China: A Cross Sectional Study. Infect Drug Resist. 2024 Mar 19;17:1085–98. Available from: https://doi.org/10.2147/IDR.S454489
Courtenay M, Hawker C, Gallagher R, Castro-Sanchez E, Gould DJ, Al Salti F, et al. The application of antimicrobial stewardship knowledge to nursing practice: A national survey of United Kingdom pre-registration nursing students. J Adv Nurs. 2025 Jan;81(1):198–209. Available from: https://doi.org/10.1111/jan.16195
Elsayed Hosny S, Mosaad Ali M, Fathy Mohamed R. Effect of Educational Guidelines regarding Preventive Measures of Antibiotic Resistance on Nursing Students’ Knowledge and Attitude. Journal of Nursing Science Benha University. 2022 Jul 1;3(2):842–55. Available from: https://doi.org/10.21608/jnsbu.2022.247767