Knowledge and perceptions of final year nursing students regarding antimicrobials, antimicrobial resistance, and antimicrobial stewardship : findings and implications to reduce resistance

Abstract: Antimicrobial resistance (AMR) is increasingly seen as the next pandemic in view of high morbidity and mortality rates, with Sub-Saharan Africa currently having the highest mortality rates driven by high rates of inappropriate prescribing in ambulatory care. In South Africa, nurses typically provide a range of services, including prescribing, in public ambulatory care clinics. However, little is currently known about the perception of final year nursing students regarding antibiotic use, AMR, and anti-microbial stewardship (AMS). Consequently, we sought to address this important evidence gap. A quantitative descriptive study using a self-administered online questionnaire via Google Forms was undertaken among six universities offering a Baccalaureus of Nursing. Knowledge on the classes of antibiotics, organisms covered, and mechanism of action was lacking. The sample size to achieve a confidence interval of 95% with a 5% error margin was 174, increased to 200 to compensate for possible attrition. Only 15.3% of nurses knew ceftazidime is not a 4th generation cephalosporin and only 16.1% knew clavulanic acid does not decrease inflammation at the site of infection. In addition, only 58.9% and 67.7% agreed that the prescribing of broad-spectrum antibiotics and poor infection control respectively increases AMR. AMS was also not a well-known concept among final year nurses. The lack of knowledge regarding antibiotics, AMR and AMS, among final year nurses can have important repercussions in practice once qualified. Consequently, this information gap needs to be urgently ad-dressed going forward with updated curricula and post-qualification educational activities to reduce AMR in South Africa