Knowledge, attitudes, and practices of ICU physicians on antimicrobial use and resistance: a scoping review.

Objective: To identify behavioral factors explored in the literature and the theoretical frameworks used to understand antimicrobial prescribing behaviors of ICU physicians. Design: Scoping review following the JBI methodology. Setting: Studies conducted in intensive care units (ICUs) across various healthcare systems. Participants: Physicians working in ICUs; studies involving other healthcare professionals or aggregating data from multiple specialties were excluded. Interventions: Not applicable. Results: From 995 records identified through PubMed, Embase, Scopus, CINAHL, and Web of Science, 18 studies met inclusion criteria. Fourteen were cross-sectional surveys and four used qualitative semi-structured interviews. Knowledge about antimicrobial use and its role in resistance was generally adequate. Attitudes reflected that beliefs, clinical uncertainty, and contextual factors influenced prescribing behaviors. Reported practices highlighted the role of adherence to institutional protocols and guidelines. Despite the behavioral focus, most studies lacked explicit use of theoretical frameworks to guide data collection or interpretation. Conclusions: Antimicrobial prescribing in ICUs is influenced by behavioral determinants that are not consistently evaluated using theoretical models. Future research on Knowledge, Attitudes, and Practices (KAP) should integrate behavioral science frameworks to enhance understanding and enable better design of stewardship interventions.