title: Not in my backyard: a systematic review of clinicians' knowledge and beliefs about antibiotic resistance.
abstract: OBJECTIVE
  To systematically review clinicians' knowledge and beliefs about the importance and causes of antibiotic resistance, and strategies to reduce resistance.
  
  
  METHODS
  Four databases were searched (until July 2014), without restrictions on language, setting or study design. Fixed responses (from surveys) were grouped into categories. The proportion of participants who agreed with each category was expressed as median, percentage and IQR. Qualitative data were coded into emergent themes. Quantitative categories and qualitative themes were grouped into four overarching categories that emerged from the data.
  
  
  RESULTS
  There were 57 included studies (38 quantitative, 14 qualitative, 5 mixed methods) of 11593 clinicians. Most clinicians (69%, IQR 63%-72%, n=5 studies) had heard of antibiotic resistance and 98% (IQR 93%-99%, n=5 studies) believed it was serious. The proportion who believed it was a problem for their practice (67%, IQR 65%-74%, n=13 studies) was smaller than the proportion who believed it was a problem globally (89%, IQR 85%-97%, n=5 studies) or nationally (92%, IQR 88%-95%, n=21 studies). Most believed excessive antibiotic use (97%, IQR 91%-98%, n=12 studies) and patient non-adherence (90%, IQR 82%-92%, n=7 studies) caused resistance. Most knew of strategies to reduce resistance (e.g. clinician education, 90%, IQR 85%-96%, n=7 studies). Qualitative findings support these data: they attributed responsibility for antibiotic resistance to patients, other countries and healthcare settings; resistance was considered a low priority and a distant consequence of antibiotic prescribing.
  
  
  CONCLUSIONS
  Clinicians believe antibiotic resistance is a serious problem, but think it is caused by others. This needs to be accommodated in interventions to reduce antibiotic resistance.
authors.affiliation: Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia amccullo@bond.edu.au.
authors.forename: A R
authors.initials: AR
authors.lastname: McCullough
authors.affiliation: Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Rathbone
authors.affiliation: Centre of National Research on Disability and Rehabilitation Medicine, Griffith Health Institute, Griffith University, Queensland 4131, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Parekh
authors.affiliation: Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia.
authors.forename: T C
authors.initials: TC
authors.lastname: Hoffmann
authors.affiliation: Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia.
authors.forename: C B
authors.initials: CB
authors.lastname: Del Mar
mesh_terms: D024881:Drug Resistance, Bacterial / Q000502:physiology*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D011361:Professional Competence