Inappropriate Antimicrobial Prescribing Patterns and Associated Factors among Outpatients in Private Hospitals in Southwest China: A Retrospective Study (2022-2025)

Introduction Inappropriate antimicrobial use is a primary driver of antimicrobial resistance. This study examines outpatient antimicrobial prescribing patterns and their associated factors in Chinese private hospitals from January 2022 to April 2025. Methods We analyzed antimicrobial prescriptions from seven private hospitals in southwest China, classifying them as appropriate or inappropriate. Chi-square tests and generalized estimating equations were applied to identify factors associated with inappropriate prescribing. Results Of 147,415 antimicrobial prescriptions, respiratory (44.4%) and genitourinary disorders (39.0%) were the leading indications, while cephalosporins (33.2%) and nitroimidazoles (23.1%) were the most commonly prescribed antimicrobial classes. The overall inappropriate prescribing rate was 63.6%, with the highest rates for genitourinary (69.6%) and respiratory (61.1%) disorders. Aminoglycosides (99.5%) and lincosamides (85.0%) showed the highest inappropriateness rates. Female patients (OR=1.181, P<0.001) and those receiving injectable therapy (OR=1.396, P<0.001) had higher odds of inappropriate prescribing. Male physicians with lower education (OR=2.971, P<0.001) had higher odds. Among older (≥35 years) and more experienced (≥10 work years) physicians, technical secondary school education conferred the highest risk (OR=3.310 and 4.810, respectively, P<0.001). Attending and chief physicians shifted from protective to risk factors with increasing work experience, while associate chief physicians showed a markedly elevated risk (OR=2.770, P<0.001). Conclusions Antimicrobial stewardship efforts should prioritize genitourinary infections, with particular attention to injectable therapies and female patients. Interventions should target male physicians with higher professional titles or lower education, especially those with more experience. This necessitates enhanced regulatory oversight and tailored training programs that address the specific needs of private hospitals. Clinical registration Not applicable.