*Purpose: The perceptions and attitude of transplant clinicians towards antimicrobial stewardship (AMS) is unclear. We conducted a survey to better understand their attitude and perceptions and to increase the effectiveness of AMS interventions in transplant recipients.

*Methods: A 23-question electronic survey was sent to members of The American Society of Transplantation (AST) from July to August, 2018.

*Results: 308 respondents were included, representing 8.8% of all AST members, and 33.3% of members self-identified as Infectious Diseases (ID) physicians. Among the respondents, 52% had >10 years of independent practice, and the largest group was ID (30.2%), followed by transplant physicians (27%). Over 90% of the respondents recognized the issue of antimicrobial resistance (AMR) and the need for judicious use of antimicrobials. Suspected source of infection was the highest-ranked determinant for antibiotic decisions, selected by 73% (180/247) of respondents, followed by local guidelines, clinical experience, and published guidelines. On the primary goal of antimicrobial stewardship programs, “Increase Appropriate Use of Antibiotics” was the most common choice in both ID (73% [57/78]) and non-ID respondents (64% [106/168]). 52% of ID respondents observed that >/=30% of their patients have had antibiotic-resistant infections, compared to 39% of non-ID respondents. Overall most (71% [190/269]) respondents reported that <30% of their patients have experienced adverse effects from antibiotics, e.g. C. difficile. 71% of respondents reported an active antimicrobial stewardship program in their transplant centers. 90% of ID respondents vs 78% of non-ID respondents noted positive impact of AMS on transplant recipients, yet 14 %( 11/79) of ID respondents vs 22 %(19/86) of non-ID respondents considered their patients to be too complex for AMS to apply. If ID was part of the AMS team, 82% of ID respondents vs 92% of non-ID respondents would be more likely to follow AMS recommendations. The most preferred AMS intervention was “Including AMS Team at Bedside Rounds” [42% (103/246)], followed by “Individualized Feedback with Peer Comparison” [35% (86/246)] and “Prescribing Restriction Policy” [33% (82/246)].

*Conclusions: AMR was recognized as significant issue in transplant recipients. AMS was perceived to contribute positively towards transplant recipients by the AST community.

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