Xiao Liu, Le Han, Peng Xian, Yue Chang, Ying Liu, Lijun Ma, Jie Ren, Yunshuang Liu, Xiaosong Wang, Yujuan Long, Li Ren, Hui Tang, Qi Liu, Ling Liang, Fang Jin, Guyan Wang
A risk-stratified, stewardship-integrated approach incorporating local epidemiology, patient-level risk factors, illness severity and rapid diagnostics may optimize timely effective therapy while preserving the long-term utility of these agents.
Inappropriate antibiotic use contributes to antimicrobial resistance, yet much stewardship evidence is cross-sectional and intention-based. We conducted a two-wave longitudinal survey of clinicians in Chinese hospitals approximately 11 months apart (baseline September-October 2024; follow-up August-September 2025) to examine whether baseline psychosocial factors predicted follow-up stewardship-aligned responses to four clinical vignettes and whether associations varied by hospital level. Among 1,420 clinicians with linked responses, higher follow-up vignette scores were independently associated with stronger reasoned-action beliefs, fewer perceived barriers, greater self-efficacy, stronger knowledge and skills, greater social support, and higher perceived patient-centred benefits in both structural equation modelling and robust regression analyses. TPB-related beliefs were not independently associated after mutual adjustment. Hospital level moderated the association between reasoned-action beliefs and follow-up vignette responses, with stronger associations in tertiary than primary hospitals. Stewardship interventions may therefore need to address capability, confidence, supportive environments, and institutional context in addition to attitudes.