ArticlePloS one2019
Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 4 of them syntheses that pooled it.
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Who cites it
37 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Factors influencing physicians' antimicrobial prescribing decisions: A systematic review of qualitative studies.British journal of clinical pharmacology · 2025Pooled it
- Clinicians' and Patients' Experiences and Perceptions on the Prevention and Management of Surgical Site Infections: A Mixed-Methods Systematic Review.Journal of clinical nursing · 2025Pooled it
- Pooled it
- Factors that influence adherence to surgical antimicrobial prophylaxis (SAP) guidelines: a systematic review.Systematic reviews · 2021Pooled it
- Results from a cluster-randomized, stepped-wedge trial testing a deliberative engagement intervention to increase guideline adherence among U.S. oral health providers.Scientific reports · 2025Trial
- Patterns of Surgical Prophylaxis Prescribing for Dentoalveolar Procedures in Australian Hospitals: 2016-2022.Australian dental journal · 2026Article
- Article
- Guideline Adherence of Perioperative Antibiotics and Surgical Site Infections in Noncardiac Surgery.JAMA network open · 2026Article
- Antimicrobial stewardship from a One Health perspective.Nature reviews. Microbiology · 2026Review
- Strategies to improve antimicrobial stewardship in surgery: insights from an ethnographic study.BMJ open · 2026Article
- Combating Antimicrobial Resistance: A Pharmacist-Led PDCA Stewardship Program in a Tertiary Hospital.Infection and drug resistance · 2026Article
- Antibiotic prescribing practices, perceived constraints, and views on antimicrobial resistance among general and orthopedic surgeons in central India.Scientific reports · 2025Article
- Antimicrobial prophylaxis for endourological procedures in Jordanian hospitals: a multi-centre qualitative study.BMJ open · 2025Article
- User perceptions of surgical antimicrobial prophylaxis guidelines in orthopaedic surgery in a tertiary Australian hospital.PloS one · 2025Article
- A qualitative study on factors influencing health workers' uptake of a pilot surgical antibiotic prophylaxis stewardship programme in selected Georgian hospitals.PLOS global public health · 2025Article
- Antimicrobial Stewardship in Healthcare: Exploring the Role of Nurses in Promoting Change, Identifying Barrier Elements and Facilitators-A Meta-Synthesis.Healthcare (Basel, Switzerland) · 2024Review
- Quality, availability and suitability of antimicrobial stewardship guidance: a multinational qualitative study.JAC-antimicrobial resistance · 2024Article
- Assessment of antimicrobial prescribing patterns, guidelines compliance, and appropriateness of antimicrobial prescribing in surgical-practice units: point prevalence survey in Malaysian teaching hospitals.Frontiers in pharmacology · 2024Article
- Article
- Vancomycin prescribing and therapeutic drug monitoring: Challenges of real clinical practice.PloS one · 2023Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSurgical antimicrobial prophylaxis (SAP) is a leading indication for antibiotic use in the hospital setting, with demonstrated high rates of inappropriateness. Decision-making for SAP is complex and multifactorial. A greater understanding of these factors is needed to inform the design of targeted antimicrobial stewardship interventions and strategies to support the optimization of SAP and its impacts on patient care.
methodsA qualitative case study exploring the phenomenon of SAP decision-making. Focus groups were conducted with surgeons, anaesthetists, theatre nurses and pharmacists across one private and two public hospitals in Australia. Thematic analysis was guided by the Theoretical Domains Framework (TDF) and the Capabilities, Opportunities, Motivators-Behaviour (COM-B) model.
resultsFourteen focus groups and one paired interview were completed. Ten of the fourteen TDF domains were identified as relevant. Thematic analysis revealed six significant themes mapped to the COM-B model, and subthemes mapped to the relevant TDF domains in a combined framework. Key themes identified were: 1) Low priority for surgical antimicrobial prophylaxis prescribing skills; 2) Prescriber autonomy takes precedence over guideline compliance; 3) Social codes of prescribing reinforce established practices; 4) Need for improved communication, documentation and collection of data for action; 5) Fears and perceptions of risk hinder appropriate SAP prescribing; and 6) Lack of clarity regarding roles and accountability.
conclusionsSAP prescribing is a complex process that involves multiple professions across the pre-, intra- and post-operative surgical settings. The utilisation of behaviour change frameworks to identify barriers and enablers to optimal SAP prescribing supports future development of theory-informed antimicrobial stewardship interventions. Interventions should aim to increase surgeon engagement, enhance the prioritisation of and accountability for SAP, and address the underlying social factors involved in SAP decision-making, such as professional hierarchy and varied perceptions or risks and fears.
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