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Background Antibiotic resistance is one of the greatest threats to global public health. Inappropriate use of antibiotics can lead to an increase in antibiotic resistance. Individual self-efficacy in the appropriate use of antibiotics plays a key role, especially in China where the population has easy access to antibiotics. However, there are no tools available to assess the self-efficacy of appropriate antibiotic use for Chinese adults. We aimed to translate and develop a Chinese version of the Appropriate Antibiotic Use Self-Efficacy Scale (AAUSES), and validate its reliability and validity. Methods A total of 659 adults were recruited to participate in the questionnaire. The original version scale was first translated into Chinese using the backward and forward translation procedures. The internal consistency reliability of the scale was measured by the Cronbach alpha coefficient, the test-retest reliability, and the corrected item-total correlation. The validity of the scale was assessed by the content validity index, exploratory factor analysis, and confirmatory factor analysis. Results The content validity index of the scale was 0.96. Exploratory factor analysis (EFA) supported a 4-factor structure of the translated questionnaire, and the discriminant validity of the scale was good. Confirmatory factor analysis (CFA) showed in the model fitness index, the chi-square degree of freedom was 2.940, the goodness-of-fit index(GFI) was 0.929, the incremental fit index (IFI) was 0.908, the comparative fit index(CFI) was 0.906, root mean square error of approximation(RMSEA) was 0.077, and standardized root mean residual (SRMR) was 0.0689, and the model fitting indexes were all in the acceptable range. Cronbach alpha coefficient for the scale was 0.910. The test-retest reliability was 0.947, and the corrected item-total correlations for the items ranged from 0.488 to 0.736. Self-efficacy for appropriate antibiotic use in adults varied by education, occupation, income, place of residence, and whether or not they had heard of antibiotic resistance. Conclusions The results indicated that the Chinese version of the AAUSES had good reliability and validity. Therefore, it can be considered a tool to evaluate the appropriate antibiotic use self-efficacy of adults in China.

To understand the reasons for the public’s irrational use of antibiotics based on the health belief model (HBM). A questionnaire survey was conducted based on cluster random sampling in Chongqing, China. The public’s antibiotic use behaviors, knowledge, perceived threat of diseases [both short-term upper respiratory tract infections (URTIs) and long-term antibiotic resistance (AR)], perceived value of antibiotic use (benefits and harm), self-efficacy, antibiotic availability and social influences were measured. Structural equation modeling (SEM) was applied to test the fitness of the survey data with the theoretical framework based on the HBM. A total of 815 respondents were enrolled. The irrational use of antibiotics was prevalent among the public (mean: 2.95, SD = 2.12). The public had limited knowledge about antibiotic use (average 29.17% correct answers to 8 questions), a high perceived threat of AR (mean = 2.46, SD = 0.64) and a moderate perceived threat of URTIs (mean = 2.13, SD = 1.04). They also perceived high benefits (mean = 2.57, SD = 0.68) and moderate harm (mean = 2.16, SD = 0.83) from antibiotic use. In addition, respondents had easy access to antibiotics (mean = 2.38, SD = 0.80), perceived a high prevalence of use of antibiotics by relatives (mean = 2.40, SD = 0.65) and had a moderate level of self-efficacy in using antibiotics (mean = 1.97, SD = 0.75). The SEM results showed that higher levels of the perceived threat of URTIs, perceived benefits of antibiotic use, self-efficacy, antibiotic availability and social influence were associated with more irrational antibiotic use behavior (p < 0.005). Moreover, higher knowledge indirectly led to irrational use of antibiotics by promoting self-efficacy (p < 0.001) and the perceived threat of URTIs (p < 0.005). To curb the irrational use of antibiotics, improving knowledge alone is insufficient. A ​​systematic approach addressing multiple dimensions of health beliefs​​ is critical. This includes: (1) ​​targeted public education campaigns​​ emphasizing the limited efficacy of antibiotics for viral infections and reframing perceptions of antibiotic “benefits”; (2) ​​regulatory measures to restrict non-prescription antibiotic sales​​ in pharmacies; (3) ​​clinical guidelines and training​​ to reduce unnecessary antibiotic prescriptions by healthcare providers; and (4) ​​community-level interventions​​ leveraging social norms to discourage inappropriate antibiotic use. Policymakers should prioritize interventions that address both individual perceptions (e.g., fear of untreated infections) and systemic drivers (e.g., antibiotic accessibility).

Antimicrobial resistance (AMR) remains a global health priority, partly driven by non-guideline-concordant antibiotic prescribing among healthcare workers. Existing interventions often overlook the psychological and contextual factors that shape prescribing behaviour. This study integrated behavioural theory with explainable machine learning to identify psychological predictors of intention to use antimicrobials appropriately among clinicians. A cross-sectional survey was conducted among 1135 healthcare workers from four public hospitals in China. Participants completed questionnaires based on constructs from the Theory of Planned Behavior, the Health Belief Model, the Theory of Reasoned Action (TRA), Self-Efficacy Theory, Social Support Theory, and cognitive processing frameworks. LASSO regression and SHAP analysis were applied alongside machine-learning classifiers (e.g., XGBoost, LightGBM, CatBoost) to identify key predictors and interactions influencing intention to use antimicrobials appropriately. Social support, cognitive processing, knowledge and skills, and health beliefs were the most important predictors. SHAP analysis revealed nonlinear interactions, particularly between social support and cognitive processing. Ensemble models achieved high predictive accuracy (F1-scores > 0.94) for high and medium intention to use antimicrobials appropriately, whereas classifying low-intention respondents remained more challenging. Combining behavioural theory with explainable AI offers a scalable approach to identifying clinicians at risk of non-guideline-concordant prescribing. These findings support the development of psychologically tailored, real-time interventions to strengthen antibiotic stewardship and address AMR across diverse health-system settings.

A survey of advanced practice clinicians (APCs), physicians, residents, and medical students at an academic medical center and community practices in southeastern Texas revealed a gap in knowledge and practice related to testing and treatment for asymptomatic bacteriuria (ASB) in older adults.

Background Inappropriate antibiotic use has become a significant driver of the global burden of antimicrobial resistance (AMR). Our study aims to identify the proportion and associated factors of inappropriate antibiotic use, including self-medication of antibiotics, and non-adherence to antibiotic prescriptions among Myanmar migrants in Thailand. Methods A cross-sectional study was conducted among 348 Myanmar migrants from three Myanmar migrant communities in Samut Sakhon, Thailand. The sample was recruited using convenience sampling, and the survey was conducted using face-to-face interviews. The variables, including predisposing, reinforcing, and enabling factors based on the PRECEDE-PROCEED model, were constructed. Descriptive statistics, Chi-square or Fisher’s Exact tests, and multiple logistic regression were performed to identify associated factors. Results The proportion of self-medication among all participants was 28.4% ( n  = 348), and non-adherence among migrants who took prescribed antibiotics was 67.5% ( n  = 249). Factors positively associated with antibiotic self-medication are; never visiting a hospital in Thailand (AOR = 3.54, 95% CI = 2.00–6.27), inability to recognize common antibiotic drugs in the photos (AOR = 2.80, 1.56–5.02), and lack of AMR information in the past year (AOR = 1.98, 1.04–3.76). Factors positively associated with non-adherence to antibiotic prescription includes alcohol drinking (AOR = 37.58, 4.55–310.63), moderate to severe legal status-related acculturative stress (AOR = 6.49, 2.10–20.05 for severe stress and AOR = 2.60, 1.20–5.68 for moderate stress), receiving information regarding antibiotic use (AOR = 2.79, 1.40–5.58), working 7 days per week (AOR = 2.36, 1.12–5.01), lack of health insurance (AOR = 2.20, 1.17–4.14) and proximity to a hospital (AOR = 2.22, 1.15–4.28). Conclusion High levels of inappropriate antibiotic use among Myanmar migrants highlight the need to integrate migrants into Thailand’s national action plan on AMR. The high prevalence of antibiotic misuse among Myanmar migrants highlights the need to include migrants in Thailand’s national plan to combat antimicrobial resistance. To improve patient understanding and adherence to treatment, healthcare professionals should provide medication guidelines and education on the risks of antimicrobial resistance. Policymakers should focus future policies and interventions on providing interpretation services and establishing institutional mechanisms to ensure migrants’ access to healthcare.

Background Urinary tract infections are common and lead to frequent and inappropriate antibiotic prescribing in primary care. The RedAres randomized controlled trial has shown to reduce second-line antibiotic use for urinary tract infections through a multimodal intervention. It included guideline recommendations for general practitioners and patients (1), provision of regional data for antibiotic resistance (2), delivering personalized feedback based on the proportion of first- and second-line antibiotic prescriptions (3), and benchmarking with regional or supra-regional practices (4). To discuss all interventions, individual telephone counselling was offered. The aim of the RedAres process evaluation is to assess the acceptability of the multimodal intervention among general practitioners and the feasibility of the study design for medical practice assistants. Methods The general practitioners and medical practice assistants surveys were conducted following the RedAres intervention during the last trial visit. To assess acceptability among general practitioners, we developed a questionnaire based on Sekhon´s theoretical framework of acceptability. The questionnaires for medical practice assistants included questions on data management feasibility and attitudes towards this task. Data were analyzed using SPSS and R. Cases were weighted according to the number of respondents per practice, descriptive statistics, chi-squared tests, bivariable logistic regressions, and multivariable logistic regressions were used for data analysis. Results The response rate to the questionnaires was 96.6% for general practitioners ( N  = 63) and 91.5% for medical practice assistants ( N  = 56). Most general practitioners (93.9%) found the multimodal intervention to be adequate for enhancing guideline adherence. Among the intervention components, resistance data (31.8%) and prescribing feedback (31.8%) were equally appreciated, while benchmarking (12.2%) was the least appreciated intervention. Most medical practice assistants (96.3%) reported being satisfied with the data collection, documentation, and transfer in the RedAres study. Conclusions The RedAres intervention was favorably received by general practitioners, medical practice assistants deemed data management and extraction feasible. With the backdrop of the intervention’s effectiveness, its favorable reception, and its practicability, antibiotic stewardship and quality control measures implemented at the practice level hold promise for effectively enhancing guideline adherence and improving antibiotic stewardship practices in real-world settings. Trial registration Prospective registration at the German Clinical Trial Register (DRKS), trial number DRKS00020389, registration date 30.01.2020 (https//drks.de/search/en/trial/DRKS00020389).

Background Appropriate antimicrobial use should be encouraged among parents to prevent the increase in antimicrobial resistance. In Japan, antibiotics are widely used in paediatrics. This study aimed to create educational animations to educate parents on the appropriate use of antibiotics and to examine the effects of different animation scenarios using message framing on the intention to use antibiotics appropriately (hereinafter referred to as ‘intention’). Methods In this intervention study, three educational animations were created: Animation A with a general message for Group A, Animation B with a gain-framing message for Group B, and Animation C with a loss-framing message for Group C. A questionnaire survey was conducted for parents of children who visited a medical facility before and after watching one of the animations. The primary questions focused on the intention to use antimicrobials appropriately and the assessment items based on the PMT that influence this intention (severity, vulnerability, response efficacy, self-efficacy, intrinsic rewards, and response costs). Results Responses were obtained from 27, 29, and 31 participants in groups A, B, and C, respectively. Intention scores increased significantly in groups A ( p  = 0.001) and C ( p  < 0.001), whereas no significant difference was observed in group B ( p  = 0.237). Effect sizes were large in groups A ( r  = 0.62) and C ( r  = 0.64) and small in group B ( r  = 0.22). Regarding the PMT assessment items, severity significantly increased in groups A ( p  < 0.001) and C ( p  = 0.001), whereas no significant difference was observed in group B ( p  = 0.589). Effect sizes were large in groups A ( r  = 0.76) and C ( r  = 0.60). Conclusions The addition of loss-framing messages to general knowledge was found to be more effective than that of gain-framing messages in improving intention. Positive expressions might reduce awareness of the severity of the risk of antimicrobial resistance and not improve intention. The use of loss-framing animation may be an effective tool for educating parents on the appropriate use of antibiotics. Trial registration Japan Registry of Clinical Trials (Registration number: jRCT1030210605; Registration date: 10 February 2022).

The increased deployment of carbapenem antibiotics has led to a rise in carbapenem-resistant Enterobacter (CRE) prevalence. Notably, the incidence of CRE-related infections in neonatal intensive care units (NICUs) has surged, presenting significant clinical challenges. This case report emphasizes the treatment of neonatal CRE infections complicated by pneumonia and renal impairment and investigates the safety of tigecycline and polymyxin in pediatric settings. We conducted a retrospective analysis of clinical data from neonates with CRE-related pneumonia and renal impairment treated with a combination of tetracycline, polymyxin, and aztreonam. The case report assessed the risks and benefits of this regimen in managing neonatal infections and optimized the therapeutic protocol accordingly. In cases requiring invasive mechanical ventilation, infants exhibited enhanced respiratory mobility, managed spontaneous breathing, and showed occasional blood oxygen level fluctuations that normalized independently. Pulmonary ultrasound findings indicated a predominance of B-lines. The intervention controlled the infection effectively, leading to the infant's recovery and subsequent hospital discharge without significant adverse events. For neonates with CRE-related pneumonia and renal dysfunction, combining tetracycline and peptide antibiotics with other drugs effective against Escherichia coli, such as aminoglycosides, has shown to lower mortality rates associated with neonatal pneumonia caused by carbapenem-resistant Gram-negative bacteria. Our findings further elucidate CRE drug resistance mechanisms, antimicrobial selection, and pediatric safety for tetracyclines and peptides. Personalized combination therapy enhances treatment efficacy and minimizes adverse effects, particularly in cases involving drug-resistant bacterial infections.

Background Antimicrobial resistance is a global patient safety priority and inappropriate antimicrobial use is a key contributing factor. Evidence have shown that delayed (back-up) antibiotic prescriptions (DP) are an effective and safe strategy for reducing unnecessary antibiotic consumption but its use is controversial. Methods We conducted a realist review to ask why, how, and in what contexts general practitioners (GPs) use DP. We searched five electronic databases for relevant articles and included DP-related data from interviews with healthcare professionals in a related study. Data were analysed using a realist theory-driven approach – theorising which context(s) influenced (mechanisms) resultant outcome(s) (context-mechanism-outcome-configurations: CMOCs). Results Data were included from 76 articles and 41 interviews to develop a program theory comprising nine key and 56 related CMOCs. These explain the reasons for GPs’ tolerance of risk to different uncertainties and how these may interact with GPs’ work environment, self-efficacy and perceived patient concordance to make using DP as a safety-net or social tool more or less likely, at a given time-point. For example, when a GP uses clinical scores or diagnostic tests: a clearly high or low score/test result may mitigate scientific uncertainty and lead to an immediate or no antibiotic decision; an intermediary result may provoke hermeneutic (interpretation-related) uncertainty and lead to DP becoming preferred and used as a safety net. Our program theory explains how DP can be used to mitigate some uncertainties but also provoke or exacerbate others. Conclusion This review explains how, why and in what contexts GPs are more or less likely to use DP, as well as various uncertainties GPs face which DP may mitigate or provoke. We recommend that efforts to plan and implement interventions to optimise antibiotic prescribing in primary care consider these uncertainties and the contexts when DP may be (dis)preferred over other interventions to reduce antibiotic prescribing. We also recommend the following and have included example activities for: (i) reducing demand for immediate antibiotics; (ii) framing DP as an ‘active’ prescribing option; (iii) documenting the decision-making process around DP; and (iv) facilitating social and system support.

Background Irrational drug use has become a global problem threatening human health. As future health professionals, medical college students’ medication literacy (ML) is critical. Their mastery of medication-related knowledge will directly affect public medication safety in the future. Methods The initial scale was developed through a literature review and was modified through expert consultation and student interviews to form the initial scale with 14 items. In 2020, a questionnaire survey was conducted among students in a medical college for item analysis, reliability test, validity test and other analyses. Results The total Cronbach’s α coefficient was 0.826 and split-half reliability was 0.852. The Cronbach’s α coefficients for functional medication literacy, communicative medication literacy, and critical medication literacy were 0.901, 0.858, and 0.851, respectively. The item-level content validity index (I-CVI) ranged from 0.833 to 1.000 (≥ 0.78). Factor analysis of 14 items showed that KMO = 0. 852(> 0.7) and Bartlett’s spherical test p  < 0.001, indicating that the data are very suitable for factor analysis. Three principal axis factors were extracted by principal component analysis, and the total variance interpretation rate was 69.031% (> 40%). The confirmatory factor analysis identified a three-factor model and showed goodness of fit indices for the scale: The χ²/df = 2.623, The Goodness of Fit Index (GFI) = 0.905, The Comparative Fit Index (CFI) = 0.950, Normed Fit Index (NFI) = 0.922, Tucker-Lewis index (TLI) = 0.938, and The Root Mean Square Error of Approximation (RMSEA) = 0.078. Conclusion A new scale for evaluating the medication literacy of Chinese medical college students was preliminarily developed, demonstrating good reliability and validity. Itcan be used as a preliminary measurement tool for assessing medical students’ medication literacy. However, due to the limitations of this study, the practical application of the scale needs to be further examined in a larger sample and should be refined in future studies.