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Chan OSK, Lam W, Zhao S, Tun H, Liu P, Wu P. Why prescribe antibiotics? A systematic review of knowledge, tension, and motivation among clinicians in low-, middle- and high-income countries. Soc Sci Med 2024; 345:116600. [PMID: 38394944 DOI: 10.1016/j.socscimed.2024.116600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 02/25/2024]
Abstract
Medical professionals such as physicians and veterinarians are responsible for appropriate antimicrobial prescription (AMP) and use. Although seemingly straightforward, the factors influencing antibiotic prescription, a category of antimicrobials, are complex. Many studies have been conducted in the past two decades on this subject. As a result, there is a plethora of empirical evidence regarding the factors influencing clinicians' AMP practices. AIM A systematic review of AMR studies on AMP was conducted, condensing findings according to a combination of the Knowledge, Attitude, and Practice (KAP) and Capacity, Opportunity, Motivation-Behavior (COM-B) models. Review findings were then synthesized and analyzed for policy implementation according to the Consolidated Framework for Implementation Research (CFIR). DESIGN AND METHODOLOGY A systematic literature review was conducted according to PRISMA guidelines to identify peer-reviewed papers indexed in pre-determined medical science, social sciences, and humanities databases that apply the KAP model in their investigations. Antimicrobial prescription factors were compared and contrasted among low- and middle-income countries (LMICs) and high-income countries (HICs). FINDINGS The KAP model is a heuristic and structured framework for identifying and classifying respondents' knowledge. However, other than medical knowledge, factors that influence prescription decision-making can be expanded to include attitudes, perception, personal affinities, professional circumstances, relational pressure, and social norms.
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Affiliation(s)
- Olivia S K Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Wendy Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Shilin Zhao
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong Special Administrative Region, China.
| | - Hein Tun
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong Special Administrative Region, China.
| | - Ping Liu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Peng Wu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Arenz L, Porger A, De Michel M, Weber A, Jung J, Horns H, Gscheidle S, Weiglein T, Pircher J, Becker-Lienau J, Horster S, Klein M, Draenert R. Effect and sustainability of a stepwise implemented multidisciplinary antimicrobial stewardship programme in a university hospital emergency department. JAC Antimicrob Resist 2024; 6:dlae026. [PMID: 38410248 PMCID: PMC10895698 DOI: 10.1093/jacamr/dlae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024] Open
Abstract
Objectives To explore effectiveness and sustainability of guideline adherence and antibiotic consumption after establishing treatment guidelines and initiating antimicrobial stewardship (AMS) ward rounds in a university hospital emergency department (ED). Methods Data were gathered retrospectively from 2017 to 2021 in the LMU University Hospital in Munich, Germany. Four time periods were compared: P1 (pre-intervention period); P2 (distribution of guideline pocket cards); P3 (reassessment after 3 years); and P4 (refresher of guideline pocket cards and additional daily AMS ward rounds for different medical disciplines). Primary outcome was adherence to guideline pocket cards for community-acquired pneumonia, cystitis, pyelonephritis and COVID-19-associated bacterial pneumonia. Secondary outcomes were reduction in antibiotic consumption and adherence to AMS specialist recommendations. Results The study included 1324 patients. Guideline adherence increased in P2 for each of the infectious diseases entities. After 3 years (P3), guideline adherence decreased again, but was mostly on a higher level than in P1. AMS ward rounds resulted in an additional increase in guideline adherence (P1/P2: 47% versus 58.6%, P = 0.005; P2/P3: 58.6% versus 57.3%, P = 0.750; P3/P4: 57.3% versus 72.5%, P < 0.001). Adherence increased significantly, not only during workdays but also on weekends/nightshifts. Adherence to AMS specialist recommendations was excellent (91.3%). We observed an increase in use of narrow-spectrum antibiotics and a decrease in the application of fluoroquinolones and cephalosporins. Conclusions Establishing treatment guidelines in the ED is effective. However, positive effects can be diminished over time. Daily AMS ward rounds are useful, not only to restore but to further increase guideline adherence significantly.
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Affiliation(s)
- Lukas Arenz
- Antibiotic Stewardship Programme, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Annika Porger
- Antibiotic Stewardship Programme, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Michaela De Michel
- Antibiotic Stewardship Programme, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Alexandra Weber
- Antibiotic Stewardship Programme, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
- Department of Hospital Pharmacy, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Jette Jung
- Antibiotic Stewardship Programme, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
- Max-von-Pettenkofer-Institute Munich, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 München, Germany
| | - Heidi Horns
- Antibiotic Stewardship Programme, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Sandra Gscheidle
- Antibiotic Stewardship Programme, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
- Department of Hospital Pharmacy, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Tobias Weiglein
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
- Emergency Department, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Joachim Pircher
- Emergency Department, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
- Department of Medicine I, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Johanna Becker-Lienau
- Emergency Department, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Sophia Horster
- Emergency Department, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Matthias Klein
- Emergency Department, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
- Department of Neurology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Rika Draenert
- Antibiotic Stewardship Programme, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
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3
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Reddy K, Ramsamy Y, Swe Swe-Han K, Nana T, Black M, Kolojane M, Chibabhai V. Antimicrobial resistance and antimicrobial stewardship in South Africa: a survey of healthcare workers in academic and nonacademic hospitals. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e202. [PMID: 38028921 PMCID: PMC10654946 DOI: 10.1017/ash.2023.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023]
Abstract
Objective Antimicrobial stewardship programmes (ASPs) facilitate appropriate antimicrobial use and require contextualization for optimal functioning. We aimed to investigate perceptions of and antimicrobial resistance (AMR) and ASPs among healthcare workers in academic and nonacademic hospitals. Design Cross-sectional survey. Setting Three academic (Charlotte Maxeke Johannesburg Academic, Inkosi Albert Luthuli, Tygerberg) and three nonacademic hospitals (Leratong, Prince Mshiyeni Memorial, and Paarl) in South Africa from January to June 2022. Participants Doctors, nurses, and pharmacists. Methods Voluntary questionnaire using Google Forms, encompassing AMR, ASPs, and selected discipline-specific components. Results Participants comprised 79 doctors (50 academic), 178 nurses (169 academic), and 21 pharmacists (18 academic) and were female predominant. AMR was a problem in academic hospitals (74.7% vs 51.2%, p 0.004); 73.5% overall reported inappropriate antimicrobial use as a major contributor. Adequate education on antimicrobials occurred in only 36.4% overall. Microbiological testing guided therapy more often in nonacademic settings (80.0% vs 50.2%, p <0.001). In both settings, antimicrobial availability drove selection in 48.2%. Overall, ASPs improved patient care (89.8%) and reduced antimicrobial use (86.9%), although felt to override prescriber autonomy in academic settings (29.4% vs 7.5%, p 0.007), mainly among nurses. Only 50.2% reported successful local ASPs. A minority of pharmacists (20.0%) reported sufficient hospital support for ASPs. Education, involvement of infection control staff, and inclusion of nurses in ASPs were most impactful on AMR. Conclusion Selected healthcare worker perspectives differ by category and setting and can be targeted to improve ASPs. Further studies should target a higher number of clinical staff in both settings.
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Affiliation(s)
- Kessendri Reddy
- Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- National Health Laboratory Service Tygerberg, Cape Town, Western Cape, South Africa
| | - Yogandree Ramsamy
- Department of Medical Microbiology, School of Laboratory Medicine & Medical Science, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Khine Swe Swe-Han
- Department of Medical Microbiology, School of Laboratory Medicine & Medical Science, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- National Health Laboratory Service Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal, South Africa
| | - Trusha Nana
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- National Health Laboratory Service Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa
| | - Marianne Black
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- National Health Laboratory Service Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa
| | - Molebogeng Kolojane
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- National Health Laboratory Service Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa
| | - Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- National Health Laboratory Service Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa
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Briquet C, Khaouch Y, Yombi JC. Perceptions, attitudes, and practices of a Belgian teaching hospital's physicians, pharmacists, and nurses regarding antibiotic use and resistance: survey towards targeted actions for Antimicrobial Stewardship. Antimicrob Resist Infect Control 2023; 12:19. [PMID: 36934291 PMCID: PMC10024823 DOI: 10.1186/s13756-023-01228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 03/10/2023] [Indexed: 03/20/2023] Open
Abstract
OBJECTIVES This study aimed to identify barriers to the proper use of antibiotics by healthcare professionals and to help the hospital Antimicrobial Stewardship develop suitable actions for the staff. METHODS In a Belgian teaching hospital, a survey was conducted among physicians, pharmacists, and nurses involved in antibiotherapy. Questions from the 2019 European Center for Disease Prevention and Control (ECDC) survey were analyzed based on components of the COM-B model (capabilities, opportunities, and motivations). First, collected data were reviewed with the Ethnos software to analyze the different COM-B model components. For statistical analyses, responses were grouped into three clear-cut answers in a Fisher's exact test. RESULTS Overall, 400 staff members were included. We found that our professions, combined, have a good perception of antibiotic resistance (97.8%). For capabilities, however, only 77.2% state that they have sufficient knowledge, with 91.3%, 71.5%, and 63.0% for physicians, nurses, and pharmacists, respectively. For opportunities (access to resources, information, and training), it is observed that 72.2% report having easy access to the guidelines they need to manage infections. In comparison, for 64.2% of the respondents, this information changed their opinion on the useless or inappropriate prescription, administration, and delivery of antibiotics. For 55.0%, this information has enabled them to change their practices. Finally, for motivations, 92.8% of respondents state that they know about the link between their practices and the emergence and spread of antibiotic resistance. However, only 65.0% of participants say they have a role in managing antibiotic resistance. We found that 5 out of 8 questions are significantly dependent on the profession: 2 inquiries related to capability, 1 to opportunity, and 2 to motivation. CONCLUSION We found that responses to the ECDC questionnaire are related to the profession. While some topics are universal/cross-functional, others must be explicitly tailored to each professional category. Information is useless if not accessible. Communication and provision of documents are thus paramount.
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Affiliation(s)
- Caroline Briquet
- Antimicrobial Stewardship, Cliniques Universitaires Saint-Luc, UCLouvain, 10 Avenue Hippocrate, 1200, Brussels, Belgium.
- Department of Pharmacy, Cliniques Universitaires Saint-Luc, UCLouvain, 10 Avenue Hippocrate, 1200, Brussels, Belgium.
| | - Youssra Khaouch
- Department of Clinical Biology, Cliniques Universitaires Saint-Luc, UCLouvain, 10 Avenue Hippocrate, 1200, Brussels, Belgium
| | - Jean Cyr Yombi
- Antimicrobial Stewardship, Cliniques Universitaires Saint-Luc, UCLouvain, 10 Avenue Hippocrate, 1200, Brussels, Belgium
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, UCLouvain, 10 Avenue Hippocrates, 1200, Brussels, Belgium
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Agossa K, Sy K, Mainville T, Gosset M, Jeanne S, Grosgogeat B, Siepmann F, Loingeville F, Dubar M. Antibiotic Use in Periodontal Therapy among French Dentists and Factors Which Influence Prescribing Practices. Antibiotics (Basel) 2021; 10:303. [PMID: 33804145 PMCID: PMC8001084 DOI: 10.3390/antibiotics10030303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 01/21/2023] Open
Abstract
The aim of the present survey is to investigate the use of antibiotics during periodontal therapy among French dentists with a focus on exploring potential differences between various groups of practitioners. A self-administered questionnaire was distributed to different groups of practitioners including members of (i) the French Society of Periodontology and Implantology; (ii) the College of University Teachers in Periodontology and, (iii) private practitioners participating in the French general dental practice-based research network. 272 questionnaires were included in the analysis. Prescription patterns were globally in line with the current recommendations. Systemic antibiotics are most frequently used as a first-line therapy in necrotizing periodontitis (92%) and aggressive periodontitis (53.3% to 66.1%). However, malpractice still exists, including in the management of periodontal abscesses. Antibiotics are prescribed (i) less frequently for periodontal abscesses and (ii) more frequently for generalized aggressive periodontitis by members of the periodontal society and University college (p < 0.05). Amoxicillin (59.9%) and the amoxicillin + metronidazole (59.6%) combination were the most frequently prescribed molecules. Providing a high number of periodontal treatments per week, being more recently graduated, having a post-graduate certificate in periodontology and holding or having held an academic position/hospital practice were all factors associated with a better knowledge of and/or more adequate antibiotic use.
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Affiliation(s)
- Kevimy Agossa
- University of Lille, Inserm, CHU Lille, U1008—Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France; (K.S.); (F.S.)
- Department of Periodontology, School of Dentistry, University of Lille, Place de Verdun, 59000 Lille, France; (T.M.); (M.D.)
| | - Kadiatou Sy
- University of Lille, Inserm, CHU Lille, U1008—Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France; (K.S.); (F.S.)
- Faculté d’Odontologie, Université de Lyon, Université Claude Bernard Lyon 1, 69008 Lyon, France;
- Hospices Civils de Lyon, Service d’Odontologie, 69007 Lyon, France
| | - Théo Mainville
- Department of Periodontology, School of Dentistry, University of Lille, Place de Verdun, 59000 Lille, France; (T.M.); (M.D.)
| | - Marjolaine Gosset
- Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496, Université de Paris, F-92120 Montrouge, France;
- Service de Médecine Bucco-Dentaire, AP-HP, Hôpital Charles Foix, F-94200 Ivry-sur-Seine, France
- SFPIO—French Society of Periodontology and Oral Implantology, 44000 Nantes, France
| | - Sylvie Jeanne
- UFR d’Odontologie de Rennes, Bâtiment 15, 2 Avenue du Professeur Léon Bernard, Campus Santé, 35043 Rennes, France;
- Pôle Odontologie, CHU Rennes, 2 Rue Henri Le Guilloux, 35000 Rennes, France
- CNEP—French College of Teachers in Periodontology, 35000 Rennes, France
| | - Brigitte Grosgogeat
- Faculté d’Odontologie, Université de Lyon, Université Claude Bernard Lyon 1, 69008 Lyon, France;
- Hospices Civils de Lyon, Service d’Odontologie, 69007 Lyon, France
- Laboratoire des Multimatériaux et Interfaces, Université de Lyon—Claude Bernard Lyon 1, UMR CNRS 5615, F-69622 Villeurbanne, France
- ReCOL—French Private Dental Practice-Based Research Network, 69007 Lyon, France
| | - Florence Siepmann
- University of Lille, Inserm, CHU Lille, U1008—Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France; (K.S.); (F.S.)
| | - Florence Loingeville
- University of Lille, CHU Lille, ULR 2694—METRICS: Evaluation of Health Technologies and Medical Practices, F-59000 Lille, France;
| | - Marie Dubar
- Department of Periodontology, School of Dentistry, University of Lille, Place de Verdun, 59000 Lille, France; (T.M.); (M.D.)
- University of Lille, Inserm, CHU Lille, UMR-S 1172 JPArc, F-59000 Lille, France
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Marta-Costa A, Miranda C, Silva V, Silva A, Martins Â, Pereira JE, Maltez L, Capita R, Alonso-Calleja C, Igrejas G, Poeta P. Survey of the Knowledge and Use of Antibiotics among Medical and Veterinary Health Professionals and Students in Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2753. [PMID: 33803226 PMCID: PMC7967476 DOI: 10.3390/ijerph18052753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 12/24/2022]
Abstract
Antimicrobial resistance (AMR) is an urgent and complex problem worldwide, exacerbated by the frequently inappropriate use of antibiotics. The purpose of this study was to survey the levels of knowledge and awareness about antibiotic use and stewardship, among human and veterinary health professionals or students in Portugal, and the associations between antibiotic knowledge factors and socio-professional groups. In cross-sectional survey design, a total of 449 online structured questionnaires were completed in 2018-2019. The statistical analysis was performed dividing the respondents into four groups, A (undergraduate students), B (PhD students and researchers), C (lecturers), and D (technicians and other occupation). Among all respondents, 17% (n = 75) revealed some gap in knowledge about antibiotic resistance and the antibiotics that should be administered for different infection types (bacterial, viral, or fungal). Of the 159 pet owners among the respondents, only half had administered antibiotics to their animal and 64% (n = 102) knew that veterinary prescription is mandatory when administering antibiotics to animals. All groups statistically agreed that the AMR is a major public health problem and the antibiotics should be administrated for bacterial infections and used until the whole pack has been finished (p = 0.00). As expected, only groups B and C demonstrated a higher level of knowledge to recognize the antibiotic name and their active ingredient than undergraduate students (p = 0.00). About the antibiotic use on pets, only group B was statistically significant to no used antibiotics on their pets (p = 0.00). However, groups A, C, and D were statistically significant for the knowledge about the mandatory veterinarian prescription and groups C and D were significantly statistics for fully aware of the transmission of bacteria between animals and humans. In conclusion, in matters related to AMR, the behavior, education, and training of the general public and health professionals, including those who prescribe antibiotics for humans and animals, need to be improved.
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Affiliation(s)
- Ana Marta-Costa
- Centre for Transdisciplinary Development Studies (CETRAD), University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal;
| | - Carla Miranda
- Microbiology and Antibiotic Resistance Team (MicroART), Department of Veterinary Sciences, University of Trás-os-Montes and Aflto Douro, 5000-801 Vila Real, Portugal; (C.M.); (V.S.); (A.S.); (J.E.P.); (L.M.)
- Associated Laboratory for Green Chemistry (LAQV-REQUIMTE), University NOVA of Lisboa, Caparica, 2829-516 Lisboa, Portugal;
| | - Vanessa Silva
- Microbiology and Antibiotic Resistance Team (MicroART), Department of Veterinary Sciences, University of Trás-os-Montes and Aflto Douro, 5000-801 Vila Real, Portugal; (C.M.); (V.S.); (A.S.); (J.E.P.); (L.M.)
- Associated Laboratory for Green Chemistry (LAQV-REQUIMTE), University NOVA of Lisboa, Caparica, 2829-516 Lisboa, Portugal;
- Department of Genetics and Biotechnology, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
- Functional Genomics and Proteomics Unit, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
| | - Adriana Silva
- Microbiology and Antibiotic Resistance Team (MicroART), Department of Veterinary Sciences, University of Trás-os-Montes and Aflto Douro, 5000-801 Vila Real, Portugal; (C.M.); (V.S.); (A.S.); (J.E.P.); (L.M.)
- Associated Laboratory for Green Chemistry (LAQV-REQUIMTE), University NOVA of Lisboa, Caparica, 2829-516 Lisboa, Portugal;
- Department of Genetics and Biotechnology, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
- Functional Genomics and Proteomics Unit, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
| | - Ângela Martins
- Animal and Veterinary Research Center (CECAV), University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal;
- Department of Zootechnics, University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal
| | - José Eduardo Pereira
- Microbiology and Antibiotic Resistance Team (MicroART), Department of Veterinary Sciences, University of Trás-os-Montes and Aflto Douro, 5000-801 Vila Real, Portugal; (C.M.); (V.S.); (A.S.); (J.E.P.); (L.M.)
- Animal and Veterinary Research Center (CECAV), University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal;
| | - Luis Maltez
- Microbiology and Antibiotic Resistance Team (MicroART), Department of Veterinary Sciences, University of Trás-os-Montes and Aflto Douro, 5000-801 Vila Real, Portugal; (C.M.); (V.S.); (A.S.); (J.E.P.); (L.M.)
- Animal and Veterinary Research Center (CECAV), University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal;
| | - Rosa Capita
- Department of Food Hygiene and Technology, Veterinary Faculty, University of León, E-24071 León, Spain; (R.C.); (C.A.-C.)
- Institute of Food Science and Technology, University of León, E-24071 León, Spain
| | - Carlos Alonso-Calleja
- Department of Food Hygiene and Technology, Veterinary Faculty, University of León, E-24071 León, Spain; (R.C.); (C.A.-C.)
- Institute of Food Science and Technology, University of León, E-24071 León, Spain
| | - Gilberto Igrejas
- Associated Laboratory for Green Chemistry (LAQV-REQUIMTE), University NOVA of Lisboa, Caparica, 2829-516 Lisboa, Portugal;
- Department of Genetics and Biotechnology, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
- Functional Genomics and Proteomics Unit, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
| | - Patrícia Poeta
- Microbiology and Antibiotic Resistance Team (MicroART), Department of Veterinary Sciences, University of Trás-os-Montes and Aflto Douro, 5000-801 Vila Real, Portugal; (C.M.); (V.S.); (A.S.); (J.E.P.); (L.M.)
- Associated Laboratory for Green Chemistry (LAQV-REQUIMTE), University NOVA of Lisboa, Caparica, 2829-516 Lisboa, Portugal;
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7
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Beović B, Doušak M, Pulcini C, Béraud G, Paño Pardo JR, Sánchez-Fabra D, Kofteridis D, Cortez J, Pagani L, Klešnik M, Nadrah K, Hafner Fink M, Nathwani D, Uhan S. Young doctors' perspectives on antibiotic use and resistance: a multinational and inter-specialty cross-sectional European Society of Clinical Microbiology and Infectious Diseases (ESCMID) survey. J Antimicrob Chemother 2020; 74:3611-3618. [PMID: 31504568 DOI: 10.1093/jac/dkz375] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/17/2019] [Accepted: 07/31/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Postgraduate training has the potential to shape the prescribing practices of young doctors. OBJECTIVES To investigate the practices, attitudes and beliefs on antibiotic use and resistance in young doctors of different specialties. METHODS We performed an international web-based exploratory survey. Principal component analysis (PCA) and bivariate and multivariate [analysis of variance (ANOVA)] analyses were used to investigate differences between young doctors according to their country of specialization, specialty, year of training and gender. RESULTS Of the 2366 participants from France, Greece, Italy, Portugal, Slovenia and Spain, 54.2% of young doctors prescribed antibiotics predominantly as instructed by a mentor. Associations between the variability of answers and the country of training were observed across most questions, followed by variability according to the specialty. Very few differences were associated with the year of training and gender. PCA revealed five dimensions of antibiotic prescribing culture: self-assessment of knowledge, consideration of side effects, perception of prescription patterns, consideration of patient sickness and perception of antibiotic resistance. Only the country of specialization (partial η2 0.010-0.111) and the type of specialization (0.013-0.032) had a significant effect on all five identified dimensions (P < 0.01). The strongest effects were observed on self-assessed knowledge and in the perception of antibiotic resistance. CONCLUSIONS The country of specialization followed by the type of specialization are the most important determinants of young doctors' perspectives on antibiotic use and resistance. The inclusion of competencies in antibiotic use in all specialty curricula and international harmonization of training should be considered.
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Affiliation(s)
- Bojana Beović
- University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - May Doušak
- Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Céline Pulcini
- Université de Lorraine, APEMAC, Nancy, France.,CHRU-Nancy, Infectious Diseases Department, Nancy, France
| | - Guillaume Béraud
- University Hospital of Poitiers, Poitiers, France.,Santé des populations et pratiques optimales en santé University Hospital of Québec-Laval University Research Center, Canada.,EA 2694 Lille University, Lille, France
| | - Jose Ramon Paño Pardo
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,IIS Aragón, Zaragoza, Spain
| | - David Sánchez-Fabra
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,IIS Aragón, Zaragoza, Spain
| | | | | | - Leonardo Pagani
- Integrated Programme for the Reduction of Maternal and Child Mortality, Instituto Marquês de Valle Flôr, Bissau, Guinea-Bissau
| | - Maša Klešnik
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Mitja Hafner Fink
- Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Dilip Nathwani
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Samo Uhan
- Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia
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8
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Di Gennaro F, Marotta C, Amicone M, Bavaro DF, Bernaudo F, Frisicale EM, Kurotschka PK, Mazzari A, Veronese N, Murri R, Fantoni M. Italian young doctors' knowledge, attitudes and practices on antibiotic use and resistance: A national cross-sectional survey. J Glob Antimicrob Resist 2020; 23:167-173. [PMID: 32971291 DOI: 10.1016/j.jgar.2020.08.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/23/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Antimicrobial resistance (AMR) is one of the major health issues worldwide. Clinicians should play a central role to fight AMR, and medical training is a pivotal issue to combat it; therefore, assessing levels of knowledge, attitudes and practices among young doctors is essential for future antimicrobial stewardship (AMS) programmes. METHODS A nationwide, cross-sectional, multicentre survey was conducted in Italy. A descriptive analysis of knowledge and attitudes was performed, along with a univariate and multivariate analysis of their determinants. RESULTS Overall, 1179 young doctors accessed the survey and 1055 (89.5%) completed all sections. Regarding the knowledge section of the questionnaire, almost all participants declared to know the different species of bacteria proposed, however the percentage of participants who correctly responded to clinical quizzes was 23% for the question on vancomycin-resistant enterococci (VRE), 42% on carbapenem-resistant Enterobacteriaceae (CRE), 32% on extended-spectrum β-lactamase-producing enterobacteria (ESBL) and 27% on methicillin-resistantStaphylococcus aureus (MRSA). Similarly, 81% of participants disagreed in stating that AMR was adequately addressed during their medical training and 71% disagreed that they received the right example from their tutors. Finally, a high rate of agreement with the proposed actions to combat AMR was documented; in particular, the percentage agreement was 76% for respondents who agreed to be part of an active surveillance system or AMS programme. CONCLUSIONS Tackling AMR should be a priority for politicians and for all health workers. Inclusion of competencies in antibiotic use in all specialty curricula is urgently needed.
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Affiliation(s)
- F Di Gennaro
- Italian Young Medical Doctors Association, Italy; Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077 Pozzilli, Italy
| | - C Marotta
- Italian Young Medical Doctors Association, Italy; Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, 86077 Pozzilli, Italy
| | - M Amicone
- Italian Young Medical Doctors Association, Italy; Department of Public Health, Nephrology Unit, University of Naples Federico II, Naples, Italy
| | - D F Bavaro
- Italian Young Medical Doctors Association, Italy; Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro', Clinic of Infectious Diseases, Piazza G. Cesare 11, 70124 Bari, Italy.
| | - F Bernaudo
- Italian Young Medical Doctors Association, Italy; Local Health Authority (ASP) Catanzaro, Italy
| | - E M Frisicale
- Italian Young Medical Doctors Association, Italy; Local Health Authority (ASL) Roma 1, Rome, Italy; Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - P K Kurotschka
- Italian Young Medical Doctors Association, Italy; Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - A Mazzari
- Division of General Surgery, Cristo Re Hospital, Rome, Italy
| | - N Veronese
- University of Palermo, Geriatrics Department, Palermo, Italy
| | - R Murri
- Department di Clinica delle Malattie Infettive, Università Cattolica S Cuore, Fondazione Policlinico A Gemelli IRCCS, Rome, Italy
| | - M Fantoni
- Department di Clinica delle Malattie Infettive, Università Cattolica S Cuore, Fondazione Policlinico A Gemelli IRCCS, Rome, Italy
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9
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Lhermie G, Gröhn YT, Serrand T, Sans P, Raboisson D. How do veterinarians influence sales of antimicrobials? A spatial-temporal analysis of the French prescribing-delivery complex in cattle. Zoonoses Public Health 2019; 67:231-242. [PMID: 31868302 DOI: 10.1111/zph.12678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/08/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In animal agriculture, antimicrobials (AM) are used to control infectious diseases whose incidence and severity vary across production systems, but may contribute to select AM resistant bacteria, potentially disseminating in humans. Antimicrobial resistance (AMR) represents a public threat, leading policymakers to implement measures to reduce antimicrobial use (AMU). Investigating AMU patterns at prescriber's level, beyond national AMU trends, enables evaluation of substitutions between AM classes (occurring when one product is replaced by another), or average consumption per production system. Our aim was to identify the influence veterinarians would exert on AMU by quantifying substitution between AM products prescribed and delivered in similar therapeutic indications, in cattle production. METHODS Monthly sales data on four critically important AM in five French areas (representative of production systems) were analysed from 2008 to 2013. We calculated the animal live weight receiving a treatment course and evaluated substitutions between brand-name and generic products, and between products from different AM classes with similar indications. RESULTS Substitutions occurred, between products of the same class (macrolides) with similar indications, between generic and brand-name products (fluoroquinolones, ceftiofur, florfenicol) and between innovative and brand-name products (marbofloxacin, ceftiofur). Innovative products reaching the market represented between 2% and 40% of the yearly sales for a given molecule, depending on the active ingredient and the area. The introduction of generic products of fluoroquinolones and ceftiofur led to a moderate adoption of the generic product at the expense of the brand-name one, unlike in human health care where the adoption reaches up to 80%. CONCLUSION Veterinary prescription remains a strong regulating power of AMU; substitutions only occurred for products with similar indications.
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Affiliation(s)
- Guillaume Lhermie
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.,IHAP, Université de Toulouse, ENVT, INRA, Toulouse, France
| | - Yrjö Tapio Gröhn
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Thomas Serrand
- IHAP, Université de Toulouse, ENVT, INRA, Toulouse, France
| | - Pierre Sans
- Université de Toulouse, ENVT, INRA, Toulouse, France
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10
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Spernovasilis N, Ierodiakonou D, Milioni A, Markaki L, Kofteridis DP, Tsioutis C. Assessing the knowledge, attitudes and perceptions of junior doctors on antimicrobial use and antimicrobial resistance in Greece. J Glob Antimicrob Resist 2019; 21:296-302. [PMID: 31726237 DOI: 10.1016/j.jgar.2019.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/26/2019] [Accepted: 11/04/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Understanding antimicrobial prescribing attitudes and perceptions, especially in the early stages of medical training, is an important driver for appropriate interventions. This study examined junior doctors' knowledge, attitudes and perceptions regarding antimicrobial use and antimicrobial resistance in Greece. METHODS A self-administered, internet-based questionnaire survey was completed by trainees and residents of all primary care centres and hospitals in Crete, Greece. RESULTS From the 313 invited junior doctors, 214 (68.4%) fully completed the questionnaire. The mean correct knowledge score (four items) was 60%. The highest confidence rates with prescribing were recorded in accurately diagnosing an infection that needs antimicrobial treatment, selecting an appropriate administration route, and selecting the appropriate dosage. The lowest confidence rates were recorded in modifying antimicrobial treatment based on clinical and/or microbiological evidence, prescribing antimicrobial combinations and not prescribing an antimicrobial in a febrile patient without severity criteria and uncertain diagnosis of infection. Use of guidelines and expert consultation were perceived as the most important factors influencing antimicrobial prescribing practices. Most participants were aware of the antimicrobial resistance problem in Greece, and considered excessive prescribing of antimicrobials and broad-spectrum antimicrobials to be the most important causes. Availability of local and national guidelines and antimicrobial resistance data, senior consultation and infectious diseases specialist consultation were the preferred interventions to improve antimicrobial prescribing. CONCLUSIONS The findings of this study will contribute to the design of appropriate interventions, based on local evidence, for the establishment of antimicrobial stewardship programs in a country characterised by excessive use of antimicrobials and high resistance rates.
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Affiliation(s)
| | - Despo Ierodiakonou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Athanasia Milioni
- Department of Otorhinolaryngology, University Hospital of Heraklion, Heraklion, Greece
| | - Lamprini Markaki
- Department of Paediatrics, General Hospital of Sitia, Sitia, Greece
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