Junior doctors' knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland

Abstract

Our objective was to assess junior doctors' perceptions of their antibiotic prescribing practice and of bacterial resistance. We surveyed 190 postgraduate doctors still in training at two university teaching hospitals, in Nice (France) and Dundee (Scotland, UK), and 139 of them (73%) responded to the survey. The main results presented in this abstract are combined for Nice and Dundee, because there was no statistical difference for these points between the two hospitals. Antibiotic resistance was perceived as a national problem by 95% of the junior doctors, but only 63% rated the problem as important in their own daily practice. Their perceptions of the causes of antibiotic resistance were sometimes at variance with available medical evidence, with excessive duration of antibiotic treatment and poor hand hygiene practices rarely being perceived as important drivers for resistance. Only 31% and 26% of the doctors knew the correct prevalences of antibiotic misuse and of methicillin-resistant Staphylococcus aureus in hospitals, respectively. They preferred educational interventions, such as specific teaching sessions, availability of guidelines or readily accessible advice from an infectious diseases specialist, to improve antibiotic prescribing, rather than restricted prescription of antibiotics. These data provide helpful information for the design of strategies to optimize adherence to good antimicrobial stewardship.

Clinicians' Knowledge, Attitudes, and Practices regarding Infections with Multidrug-Resistant Gram-Negative Bacilli in Intensive Care Units

“…26,27 Previous studies have found that respondents underestimated the prevalence of resistance, particularly at their own institution. 21,24,25 As noted in previous studies and our study, most healthcare providers believed that excess use of antimicrobials was a cause of resistance, 24,25 but fewer believed that antimicrobials were overused in the hospitals in which they worked. 22,23 Our survey uncovered a substantial knowledge gap which may delay appropriate implementation of transmission precautions and thus facilitate transmission of multidrugresistant organisms.…”

“…22,23,25 As we and others have noted, interactive education appears to be generally preferred to didactic sessions or handouts as reflected in providers' desire for feedback or preference for the advice of local experts and local resources. 21,25 As further evidence of the effectiveness of prescriber audit and feedback, this evidence-based strategy is recommended to improve antimicrobial stewardship. 29 This study had several limitations.…”

“…20 Several surveys about antimicrobial resistance have been conducted with different types of healthcare workers, including medical students, residents, and attending physicians (Table 6). [21][22][23][24][25] These previous studies have found that 87% to 97% of respondents viewed resistance as a national problem while fewer (55% to 93%) viewed resistance as a local problem. 17,19,[21][22][23][24] In contrast, we found that the vast majority of respondents at our institution agreed that MDR-GNB infections were a serious problem in ICUs both in the U.S. and at our medical center.…”

“…Previous studies have also explored the educational needs of healthcare professionals regarding antimicrobial use and resistance (Table 6). [21][22][23][24][25] Many respondents desired educational sessions on antimicrobial use, prescribing guidelines, and feedback on their prescribing practices. 22,23,25 As we and others have noted, interactive education appears to be generally preferred to didactic sessions or handouts as reflected in providers' desire for feedback or preference for the advice of local experts and local resources.…”

“…[21][22][23][24][25] Many respondents desired educational sessions on antimicrobial use, prescribing guidelines, and feedback on their prescribing practices. 22,23,25 As we and others have noted, interactive education appears to be generally preferred to didactic sessions or handouts as reflected in providers' desire for feedback or preference for the advice of local experts and local resources. 21,25 As further evidence of the effectiveness of prescriber audit and feedback, this evidence-based strategy is recommended to improve antimicrobial stewardship.…”