Antibiotic Resistance

Wester, C. William; Durairaj, Lakshmi; Evans, Arthur T.; Schwartz, David N.; Husain, Shahid; Martinez, Enrique

doi:10.1001/archinte.162.19.2210

Cited by 144 publications

(45 citation statements)

References 31 publications

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“…However, only 66.6% and 77.4% of respondents favoured antibiotic restriction policy and reduction of antibiotic use for outpatients, respectively. This finding is in agreement with a previous report on beliefs of physicians from USA [11]. Establishing local antimicrobial susceptibility tests and providing education on antimicrobials stewardship for health professional were identified as the most important interventions [14,19].…”

Section: Discussionsupporting

confidence: 91%

Knowledge and beliefs on antimicrobial resistance among physicians and nurses in hospitals in Amhara Region, Ethiopia

Abera

Kibret

Mulu

2014

BMC Pharmacol Toxicol

135

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BackgroundAntimicrobial resistance (AMR) is a major global public health problem both in hospital and community acquired infections. The present study assessed the knowledge and beliefs on AMR among physicians and nurses in 13 hospitals in Amhara region, Ethiopia, which is a low-income country.MethodsA cross-sectional study using a self-administered questionnaire was applied.ResultsA total of 385 participants (175 physicians and 210 nurses) took part in the study. Sixty five percent of physicians and 98% of nurses replied that they need training on antimicrobial stewardship. Only 48% of physicians and 22.8% of nurses had exposures for local antibiogram data. Overall, 278 (72.2%) of participants were knowledgeable about AMR. Majority of participants agreed or strongly agreed AMR as worldwide and national problem but few considered AMR as problem in their own hospitals. The two most important factors mentioned for AMR development were patients’ poor adherence to prescribed antimicrobials (86%) and overuse of antibiotics (80.5%). The most leading local factors identified for AMR development were: self-antibiotic prescription (53.5%), lack of access to local antibiogram data (12.3%) and prescriber poor awareness about AMR (9.2%). Factors perceived for excessive antibiotic prescriptions were: patient drive (56%), treatment failure (79%), unknown febrile illnesses (39.7%) and upper respiratory tract infections (33.4%).ConclusionMajority of physicians and nurses lack up to-date knowledge on AMR. Unavailability of local antibiogram data, self-prescription by patients and poor awareness on AMR are areas of interventions for prevention and control of AMR.

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Section: Discussionsupporting

confidence: 91%

Knowledge and beliefs on antimicrobial resistance among physicians and nurses in hospitals in Amhara Region, Ethiopia

Abera

Kibret

Mulu

2014

BMC Pharmacol Toxicol

135

View full text Add to dashboard Cite

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“…First, up to 20 % of junior doctors, mainly 1 st year post-qualification, did not take into consideration AMR when prescribing antimicrobials; such awareness only becomes prevalent in later years, indicating a need for targeted education on the practical implications of AMR early in post-graduate education. Of note, whilst 20 % of prescribers declared that they do not consider AMR when prescribing, there is perhaps cause for optimism given comparator data on appreciation of AMR in prescribing from previous studies [15, 26]. Second, one of the key antimicrobial stewardship principles - “Start Smart and then Focus” [23] - (which promotes the review of the prescriptions every 24 h with de-escalation from intravenous to oral when possible), is practiced twice as frequently by the 2 nd year post-qualified junior doctors than 1 st or ≥3 rd years.…”

Section: Discussionmentioning

confidence: 99%

A needs assessment study for optimising prescribing practice in secondary care junior doctors: the Antibiotic Prescribing Education among Doctors (APED)

et al. 2016

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BackgroundAppropriate antimicrobial prescribing is essential for patient care, yet up to half of antimicrobial prescriptions written in the UK are sub-optimal. Improving prescriber education has recently been promoted as a mechanism to optimise antimicrobial use, but identification of key learning objectives to facilitate this is so far lacking. Using qualitative methods we investigated junior doctor knowledge, attitudes, and behaviours around antimicrobial prescribing to identify key areas to address in future educational programmes.MethodsA cross-sectional survey of qualified doctors in training in West London was undertaken exploring antimicrobial prescribing practices and educational needs.ResultsAmong 140 junior doctors from 5 London hospitals, a third (34 %) reported prescribing primarily unsupervised, and two thirds (67 %) reported difficulties obtaining prescribing support outside of hours. 20 % stated not feeling confident in writing an antimicrobial prescription, but confidence was increased through having confirmatory diagnostic results (24) and obtaining advice from a senior doctor (26 %); whether this senior was from their own specialty, or an infection-specialist, varied significantly (p < 0.01) by experience. Only a small percentage (5–13 %; depending on number of years post-qualification) of participants stated their previous antimicrobial education was effective. 60 % of those in their first year post qualification reported wanting further education in antimicrobial prescribing, rising to 74 % among more experienced junior doctors. Specific areas of educational need identified were (i) principles of antimicrobial prescribing, (ii) diagnosis of infections, (iii) clinical review of patients with infections, (iv) prescribing in the context of antimicrobial resistance, and (v) laboratory testing and test results.ConclusionsA significant proportion of junior doctors report lone prescribing of antimicrobials in the context of low self-perceived confidence and knowledge in this field, and frequent difficulty in accessing help when necessary. Innovative training, targeting five specific areas identified through this needs assessment, is urgently needed by junior doctors practising in secondary care.

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“…Another review concludes that cultural, contextual and behavioural factors need to be addressed to influence antimicrobial use [10]. Both qualitative and quantitative studies have been performed on the topic [11–18], however, we report on the first qualitative study in Norway investigating factors influencing antimicrobial prescribing practices among hospital doctors.…”

Section: Introductionmentioning

confidence: 99%

An antimicrobial stewardship program initiative: a qualitative study on prescribing practices among hospital doctors

Skodvin

Aase

Charani

et al. 2015

Antimicrob Resist Infect Control

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BackgroundNorway has a low, but increasing prevalence of resistance and few antimicrobial stewardship initiatives. When developing stewardship interventions, an understanding of the determinants of antimicrobial prescribing is needed. We report on the first qualitative study investigating factors influencing doctors’ antimicrobial prescribing practices in Norwegian hospitals.MethodsQualitative semi-structured interviews were conducted with 15 Norwegian hospital doctors prescribing antimicrobials to adult patients. Interviews were transcribed verbatim and thematic analysis was applied to analyse the data.ResultsColleagues, in particular infectious disease specialists, microbiology test results and the newly published national guideline on antimicrobials were identified as key factors influencing antimicrobial prescribing practices. Delayed availability was a barrier for the utilization of microbiology test results and increasing clinical experience overrides the influence of the national guideline.Patient assessment, informal training by experienced colleagues, and infectious disease specialists replacing managers in promoting prudent prescribing policies, also influenced prescribing practices.ConclusionThis study identified the following contextual factors that need to be addressed when developing antimicrobial stewardship programs in Norway: a common work practice for seeking collegial advice, logistics of microbiology test results, and formal leadership and systematic training on prudence. Other countries initiating stewardship programmes may benefit from performing a similar mapping of facilitators and barriers, to identify important stakeholders and organisational obstacles, before developing sustainable and tailored antimicrobial stewardship interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-015-0065-4) contains supplementary material, which is available to authorized users.

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Antibiotic Resistance

Cited by 144 publications

References 31 publications

Knowledge and beliefs on antimicrobial resistance among physicians and nurses in hospitals in Amhara Region, Ethiopia

Knowledge and beliefs on antimicrobial resistance among physicians and nurses in hospitals in Amhara Region, Ethiopia

A needs assessment study for optimising prescribing practice in secondary care junior doctors: the Antibiotic Prescribing Education among Doctors (APED)

An antimicrobial stewardship program initiative: a qualitative study on prescribing practices among hospital doctors

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