Antimicrobial stewardship among Japanese obstetricians and gynecologists: A nationwide questionnaire-based survey of knowledge, awareness, and practice

Abstract

Background

Antimicrobial resistance (AMR) is a global threat; however, data on stewardship awareness and practices among Japanese obstetricians and gynecologists are limited. The aim of this study was to establish a baseline understanding of AMR-related knowledge, attitudes, and practices to identify challenges and guide future interventions in this specialty.

Methods

A cross-sectional anonymous questionnaire survey was conducted among members of the Japan Society of Obstetrics and Gynecology in early 2025. The survey assessed awareness of the national AMR Action Plan, knowledge of antibiotic properties, and self-reported clinical practices, including pretreatment culturing and de-escalation.

Results

In total, 442 physicians responded to the questionnaire. A significant gap between awareness and practice was identified: although 72 % of the respondents reported high awareness of stewardship, only 27.6 % were aware of the high bioavailability of first-generation cephalosporins, and only 19.0 % regularly performed de-escalation. Furthermore, a widespread lack of familiarity with support systems was evident. Only 23.3 % of physicians understood the national AMR Action Plan and only 25.1 % confirmed the presence of an antimicrobial stewardship team (AST) at their institution.

Conclusion

Japanese obstetricians and gynecologists demonstrated a critical disconnect between stewardship awareness and the practical knowledge required for its application, alongside low recognition of national and institutional guidelines. Targeted educational interventions and improved integration with local ASTs are essential to address these gaps.