Perception, Attitude, and Confidence of Physicians About Antimicrobial Resistance and Antimicrobial Prescribing Among COVID-19 Patients: A Cross-Sectional Study From Punjab, Pakistan

Abstract

Background: Patients with coronavirus disease 2019 (COVID-19) could experience multiple coinfections, and judicial antimicrobials, including antibiotics, is paramount to treat these coinfections. This study evaluated physicians’ perception, attitude, and confidence about antimicrobial resistance (AMR) and antimicrobial prescribing in patients with COVID-19.Methods: A self-administered and validated online questionnaire comprised of six sections was disseminated among physicians working in public sector hospitals in Punjab, Pakistan, using the convenience sampling method from April to May 2021. The study also assessed the validity and reliability of the study questionnaire using exploratory factor analysis and Cronbach’s alpha. In addition, the descriptive and inferential statistics present survey results.Results: A total of 387 physicians participated in this study. The study showed that the questionnaire demonstrated good internal consistency (Cronbach’s alpha = 0.77). Most physicians (n = 221, 57.1%) believed that AMR is a considerable problem in Pakistan. Less than a quarter of respondents (n = 91, 23.5%) consulted with local antibiotic resistance data to prescribe antibiotics in COVID-19 patients. However, the respondents were confident to select a suitable antibiotic (n = 229, 59.2%). More than three-quarters of the respondents believed that advice from a senior colleague (n = 336, 86.8%), infectious disease (ID) physician (n = 315, 81.4%), and implementing antimicrobial stewardship programs (ASPs) could facilitate appropriate prescribing of antibiotics in COVID-19 patients. Multivariate logistic regression revealed that physicians with more than 10 years of experience had higher odds of consulting local guidelines for antibiotic therapy (OR, 4.71 95% CI: 1.62–13.73, p = 0.004) than physicians with less than 5 years of experience. Similar trends were found for consulting national guidelines and local resistance data to select an empiric antibiotic therapy.Conclusion: AMR-related awareness was optimal among physicians. Only a few physicians looked up local antibiotic resistance data before prescribing antibiotics to COVID-19 patients empirically. The significant approaches advised by physicians to reduce AMR risk among COVID-19 patients were the implementation of ASPs combined with advice from ID physicians.

Antibiotic Use and Bacterial Infection in COVID-19 Patients in the Second Phase of the SARS-CoV-2 Pandemic: A Scoping Review

“…Clinicians’ attitudes towards antibiotic prescribing in COVID-19 patients may have also been influenced by the introduction of treatment guidelines for COVID-19 patients (such as those issued by the WHO [ 13 ] and UK NICE [ 14 ]), which advised against antibiotic use in mild COVID-19 patients and in moderately ill patients without a suspected or confirmed bacterial infection. A cross-sectional study in Pakistan [ 23 ] that evaluated physicians’ perceptions, attitudes and confidence about AMR and antibiotic prescribing in COVID-19 patients from Apr to May 2021, found that most physicians had a high awareness of AMR during the pandemic and were confident about antibiotic prescribing in COVID-19 patients.…”

Azithromycin use and outcomes in patients with COVID-19: an observational real-world study

“…The improper use of antibiotics in patients without a bacterial infection might also cause a cytokine-mediated over-activation of the immune system and a septic shock-like phenomenon, thus worsening the hyper-inflammation stimulated by COVID-19 (Wypych et al, 2018, McAleer et al, 2018, Marsland et al, 2015. Another possible explanation might be related to patients' and clinicians' risk perception and differences in disease management over time (Arefi et al, 2022, Hayat et al, 2022. In fact, during the early phases of the pandemic the intensity of COVID-19 patients care was mainly based on empirical evidence such as disease severity, clinical symptoms, and risk of disease progression (Jampani et al, 2021).…”

Nurses’ Perceptions, Involvement, Confidence and Perceived Barriers Towards Antimicrobial Stewardship Program in Pakistan: Findings from a Multi-Center, Cross-Sectional Study

“…The study instrument used in our survey was developed from relevant studies conducted among health care professionals. [37][38][39][40] Various concurrent activities were subsequently undertaken to ensure internal consistency, validity and robustness of the questionnaire used in the principal study. Firstly, the initial study questionnaire was carefully reviewed by a multidisciplinary team comprising a practicing MSN (Master of Science in nursing) nurse and two academic staff with PhDs in pharmacy to determine the content validity of the questionnaire.…”