{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:14:54Z","timestamp":1788437694896,"version":"build-2803163510"},"reference-count":11,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH Sponsored Morehouse School of Medicine Research Endowment","award":["767848"],"award-info":[{"award-number":["767848"]}]},{"award":["767848"],"award-info":[{"award-number":["767848"]}],"id":[{"id":"https:\/\/ror.org\/01cwqze88","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Antimicrobial resistance threatens public health globally, and critical access hospitals (CAHs) serving rural communities face structural barriers to implementing antibiotic stewardship programs (ASPs). This study evaluated whether a regional educational intervention could improve antimicrobial stewardship knowledge and implementation among rural healthcare professionals. Methods: A quantitative, quasi-experimental repeated cross-sectional evaluation was conducted following Antibiotic Stewardship conferences in 2023 and 2024. Participants from 38 rural and critical access hospitals completed pre-conference, post-conference, 6-month follow-up, and implementation surveys. Quantitative data were analyzed using descriptive statistics and unpaired chi-square tests, with Fisher\u2019s exact test substituted where expected cell counts were below 5, with significance set at p &lt; 0.05. Results: Seventy healthcare professionals participated across both years. Correct identification of the use of an antibiogram to guide empiric (rather than definitive) therapy improved from 27% pre-conference to 58% post-conference (p = 0.029). Confidence in antibiogram interpretation increased from 67% to 100% post-intervention (p = 0.004, Fisher\u2019s exact) but declined to 50% (5 of 10) at 6-month follow-up. Knowledge of the minimum isolate threshold required to construct an antibiogram improved from 23% (7 of 30) pre-conference to 64% (7 of 11) at 6-month follow-up (p = 0.026, Fisher\u2019s exact). Despite this, prescribing intent for conditions where antibiotics are typically unnecessary showed minimal improvement: recommendations for antibiotic use in middle ear infections decreased from 50% to 36.84%, and for mpox from 20% to 15.79%. All participants reported intent to modify clinical practice; however, time constraints, technology limitations, and lack of resources were consistently cited as primary barriers for implementation across both survey years. Conclusions: A regional educational intervention improved short-term antimicrobial stewardship knowledge and confidence among rural healthcare professionals, but knowledge retention declined over time and structural barriers persisted. Education alone is insufficient; sustained reinforcement and rural-adapted ASP models incorporating protected ASP time, decision-support tools and external partnerships are needed to translate knowledge gains into consistent stewardship practice.<\/jats:p>","DOI":"10.3390\/antibiotics15090859","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:08:53Z","timestamp":1788433733000},"page":"859","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Educational Intervention Improves Antimicrobial Stewardship Knowledge but Reveals Persistent Barriers in Rural Hospitals"],"prefix":"10.3390","volume":"15","author":[{"given":"Jack H.","family":"Lambert","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences, Mercer University School of Medicine, Macon, GA 31207, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rayven","family":"Todd","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W.","family":"Bagwell","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Mercer University School of Medicine, Macon, GA 31207, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damani","family":"Andre","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raybun","family":"Spelts","sequence":"additional","affiliation":[{"name":"Archbold Memorial Regional Medical Centre, Thomasville, GA 31792, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fantasia","family":"Gorham","sequence":"additional","affiliation":[{"name":"Georgia Department of Public Health, Atlanta, GA 30334, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Woods","sequence":"additional","affiliation":[{"name":"Georgia Department of Public Health, Atlanta, GA 30334, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9573-3412","authenticated-orcid":false,"given":"Ayomide H.","family":"Adeyemi","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shondia","family":"Evans","sequence":"additional","affiliation":[{"name":"Georgia Hospital Association, Atlanta, GA 30339, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Ponce-Terashima","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mercer University School of Medicine, Macon, GA 31201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8574-9747","authenticated-orcid":false,"given":"Kenneth I.","family":"Onyedibe","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"ref_2","unstructured":"GBD Antimicrobial Resistance Collaborators (2024). 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