Background: The rising prevalence of antimicrobial resistance (AMR) poses a critical global health challenge. Healthcare workers (HCWs) play a pivotal role in combating AMR by implementing effective preventive strategies and adhering to good practices. This study aimed to evaluate the global knowledge, attitudes, and practices (KAP) of HCWs towards AMR.

Methods: A comprehensive search of PubMed/MEDLINE, ScienceDirect, Scopus, Web of Science, Cochrane Library, and Google Scholar was conducted for English-language articles published up to August 2024. Inclusion criteria were observational studies reporting KAP data among HCWs related to AMR. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Statistical analyses, including heterogeneity (I² statistic, Cochran Q), were conducted using STATA version 14. Random-effects models were applied for pooled estimates, and subgroup analyses, meta-regression, and sensitivity analyses were performed. Publication bias was assessed via Egger's test and adjusted using the trim-and-fill method. Geographical distribution was analyzed with ArcGIS 10.3 software, and evidence certainty was evaluated using the GRADE framework.

Results: A meta-analysis of 108 studies involving 29,433 HCWs assessed their knowledge of AMR. Additionally, 51 studies with 13,660 HCWs evaluated attitudes, and 43 studies with 10,569 HCWs examined practices regarding AMR. The pooled proportion of HCWs with good knowledge of AMR was 56.5% (95% CI: 50.4-62.6%, I² = 99.5%), with the highest prevalence in Europe (70.3%) and the lowest in the Western Pacific (45.9%). Positive attitudes towards AMR were reported in 60.4% (95% CI: 48.5-72.3%, I² = 99.8%), with the highest prevalence in the Eastern Mediterranean Region (64.5%) and among those with less than five years of experience (77.8%). Good practices were observed in 48.5% (95% CI: 36.5-60.5%, I² = 99.7%), with the highest adherence in Europe (56.6%) and the lowest in Africa (39.1%). Subgroup analysis revealed that younger HCWs (under 30 years) showed better KAP scores across all domains.

Conclusion: The findings underscore the need for targeted interventions to enhance the knowledge, attitudes, and practices of HCWs regarding AMR. Priority should be given to designing and implementing robust training programs tailored to the specific needs of HCWs in resource-constrained settings. Strengthening AMR-related education and practice among HCWs is crucial for combating the global AMR crisis effectively.

Keywords: Antibiotic resistance; Antimicrobial stewardship; Global health; Health personnel.

© 2025. The Author(s).

背景： 抗菌药物耐药性（AMR）的日益流行构成了一个重大的全球健康挑战。医疗保健工作者（HCWs）通过实施有效的预防策略和遵守良好实践，在对抗 AMR 方面发挥着关键作用。本研究旨在评估 HCWs 对抗 AMR 的知识、态度和行为（KAP）。

方法： 在 PubMed/MEDLINE、ScienceDirect、Scopus、Web of Science、Cochrane Library 和 Google Scholar 中进行了全面的搜索，以查找截至 2024 年 8 月发表的英文文章。纳入标准是报告与 AMR 相关 HCWs KAP 数据的观察性研究。使用 Joanna Briggs Institute 批判性评价清单评估了研究质量。利用 STATA 软件版本 14 进行统计分析，包括异质性（I² 统计量、Cochran Q）。应用随机效应模型进行合并估计，并进行了亚组分析、元回归和敏感性分析。通过 Egger 检验评估了发表偏差并使用 trim-and-fill 方法进行了调整。利用 ArcGIS 10.3 软件对地理分布进行了分析，使用 GRADE 框架评价证据的确定性。

结果： 对 108 项研究进行的荟萃分析涉及 29,433 名 HCWs，评估了他们对抗 AMR 的知识。另外有 51 项研究涉及 13,660 名 HCWs 对他们的态度进行了评估，而 43 项研究涉及 10,569 名 HCWs 对抗 AMR 实践进行了评价。所有 HCWs 中具有良好抗菌药物耐药性知识的合并比例为 56.5%（95% CI：50.4-62.6%，I² = 99.5%），在欧洲的比例最高（70.3%）和西太平洋地区最低（45.9%）。报告对抗 AMR 的积极态度的 HCWs 比例为 60.4%（95% CI：48.5-72.3%，I² = 99.8%），在东地中海区域的比例最高（64.5%）和具有不到五年经验的人中比例最高（77.8%）。良好实践的 HCWs 比例为 48.5%（95% CI：36.5-60.5%，I² = 99.7%），在欧洲地区遵从性最高（56.6%）和非洲最低（39.1%）。亚组分析显示，年轻 HCWs（不到 30 岁）在所有领域中表现出更好的 KAP 得分。

结论： 研究结果强调了为提高 HCWs 在抗菌药物耐药性方面的知识、态度和行为而进行针对性干预的必要性。应优先设计并实施针对资源匮乏环境中 HCWs 特定需求的培训项目。加强 HCWs 的 AMR 相关教育与实践对有效应对全球抗菌药物耐药性的危机至关重要。

关键词： 抗生素抗性；抗菌药物管理；全球健康；卫生人员。