Assessing the Knowledge, Attitude, and Practices of Surgical Residents Regarding Surgical Antimicrobial Prophylaxis at Tikur Anbessa Specialized Hospital, Ethiopia
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Date
2026-08-09
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Addis Ababa University
Abstract
Background: Inappropriate use of surgical antimicrobial prophylaxis (SAP) contributes significantly to surgical site infections and antimicrobial resistance in developing countries. At Tikur Anbessa Specialized Hospital (TASH), Ethiopia's largest pediatric referral center, the quality of SAP for children is a significant concern. The knowledge, attitudes, and practices of surgical residents regarding pediatric SAP have not been systematically studied.
Objective: This study aimed to assess the knowledge, attitudes, and practices of surgical residents regarding pediatric surgical antimicrobial prophylaxis at TASH and to identify barriers and facilitators to appropriate SAP use. Methods: An institution-based cross-sectional study was conducted from September to December 2025 at TASH. A census approach was used, inviting all eligible surgical residents who operate on pediatric patients across five surgical departments. Data were collected using a structured, self-administered questionnaire. Knowledge, attitude, and practice were assessed using composite scores and dichotomized at the sample mean. Descriptive statistics, chi square tests, and binary logistic regression were performed using SPSS version 27. Results: Eighty-nine surgical residents participated in the study, representing a response rate of 76.7%. The mean knowledge score was 4.6 out of 9, with 50.6% classified as having good knowledge. The mean attitude score was 34.6 out of 45, with 47.2% demonstrating favorable attitudes. The mean practice score was 3.3 out of 5, with 46.1% reporting good practice. Single-dose sufficiency (94.4%) and vancomycin for MRSA coverage (89.9%) were the most correctly answered knowledge items, while first-line agent identification (38.2%) and penicillin allergy alternatives (38.2%) were the weakest. Senior residency status was independently associated with good knowledge (adjusted odds ratio 5.49, p = 0.001). The most frequently reported barrier was lack of clear hospital guidelines (66.3%), and the most endorsed facilitator was availability of clear SAP guidelines (80.9%).
Conclusion: Approximately half of surgical residents at TASH demonstrated adequate knowledge, favorable attitudes, and good practices regarding pediatric SAP. However, substantial gaps remain, particularly in knowledge of appropriate antibiotic selection and timing. The convergence of lack of guidelines as both the primary barrier and the most desired facilitator indicates a clear need for development and implementation of standardized, pediatric-specific SAP protocols at TASH. Educational programs targeting identified v knowledge gaps, establishment of audit and feedback systems, and integration within an antimicrobial stewardship program are recommended to improve SAP practices and reduce surgical site infections.
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Surgical antimicrobial prophylaxis, knowledge-practice gap, pediatric surgery, antimicrobial resistance, Ethiopia