Knowledge gaps influencing inappropriate surgical antibiotic prophylaxis prescribing in Kuwait: qualitative study

Introduction:
Inappropriate surgical antibiotic prophylaxis (SAP) prescribing is a major contributor to antimicrobial resistance and suboptimal surgical outcomes. Findings from our point prevalence survey (PPS) revealed significant deviations from SAP guidelines in obstetric and gynaecological surgery in Kuwait. This study investigated the role of knowledge gaps in driving inappropriate prescribing.

Methods:
Semi-structured interviews were conducted with thirteen healthcare professionals, consultants and registrars, in multiple hospitals in Kuwait. Thematic analysis guided by COM-B (Capability, Opportunity, Motivation, Behaviour) was employed to explore how knowledge influences SAP prescribing to explain the PPS results.

Results:
Analysis identified critical knowledge-related factors contributing to inappropriate SAP prescribing. Limited awareness of guidelines was evident, with registrars often relying on consultants, perpetuating outdated practices. Misconceptions about the type and duration of SAP were common. Prolonged postoperative antibiotic prescribing beyond guidelines was frequently justified by perceived safety concerns. Participants highlighted the absence of structured training programs to enhance their knowledge of evidence-based SAP prescribing, emphasising the need for mandatory courses on antibiotics for all healthcare staff. Knowledge gaps contributed to the routine use of broad-spectrum antibiotics and unnecessary anaerobic cover with metronidazole, reflecting outdated and empirical prescribing behaviours.

Conclusions:
The findings underscore the need for structured education and training programs, clear and accessible guidelines, and regular audits to reinforce evidence-based practice. Bridging these gaps could reduce inappropriate SAP prescribing, mitigate antimicrobial resistance, and improve surgical outcomes.