Physician knowledge, attitudes, and perceptions of antibiograms: a pre-implementation study in southern Sri Lanka.

Objective: The purpose of this study is to explore physicians' knowledge, attitudes, and perceptions toward antibiograms and identify perceived barriers and facilitators to their implementation in a low-resource setting in Sri Lanka. Design: A qualitative study utilizing semi-structured interviews and thematic analysis. Setting: A public tertiary care hospital in southern Sri Lanka. Participants: Thirty physicians working in pediatric and adult medical wards were purposively sampled and interviewed between June and August 2023. Results: Most physicians had limited prior knowledge or experience with antibiograms. However, after receiving a brief explanation, 29 out of 30 participants expressed strong support for implementing antibiograms, citing potential benefits such as improved antibiotic prescribing, reduced antimicrobial resistance (AMR), and enhanced patient outcomes. Approximately one-third of participants expressed concerns about feasibility due to time constraints, limited laboratory infrastructure, and personnel shortages. Participants recommended delivering antibiogram training through small-group sessions led by a multidisciplinary team. Thematic analysis identified three core themes: (1) limited baseline knowledge of antibiograms, (2) perceived clinical value and enthusiasm for implementation, and (3) barriers related to healthcare system constraints. Conclusions: Physicians in this LMIC setting demonstrated high interest in using antibiograms to guide empiric antibiotic therapy and address AMR. Despite logistical and infrastructural challenges, tailored training and stakeholder engagement may facilitate the successful development and use of antibiograms in similar resource-limited settings.