Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2025-01-05T01:59:06.208Z Has data issue: false hasContentIssue false
  • English
  • Français

Knowledge, Attitudes, and Practices Regarding Antimicrobial Use and Stewardship Among Prescribers at Acute-Care Hospitals

Published online by Cambridge University Press:  06 February 2018

Elizabeth Salsgiver ,
Daniel Bernstein ,
Matthew S. Simon ,
Daniel P. Eiras ,
William Greendyke ,
Christine J. Kubin ,
Monica Mehta ,
Brian Nelson ,
Angela Loo  and
Liz G. Ramos
...Show all authors
Elizabeth Salsgiver
Affiliation:
Weill Cornell Medicine, New York, New York
Daniel Bernstein
Affiliation:
Weill Cornell Medicine, New York, New York
Matthew S. Simon
Affiliation:
Weill Cornell Medicine, New York, New York NewYork-Presbyterian Hospital, New York, New York
Daniel P. Eiras
Affiliation:
Weill Cornell Medicine, New York, New York
William Greendyke
Affiliation:
Columbia University Medical Center, New York, New York
Christine J. Kubin
Affiliation:
NewYork-Presbyterian Hospital, New York, New York Columbia University Medical Center, New York, New York
Monica Mehta
Affiliation:
NewYork-Presbyterian Hospital, New York, New York
Brian Nelson
Affiliation:
NewYork-Presbyterian Hospital, New York, New York
Angela Loo
Affiliation:
NewYork-Presbyterian Hospital, New York, New York
Liz G. Ramos
Affiliation:
NewYork-Presbyterian Hospital, New York, New York
Haomiao Jia
Affiliation:
Columbia University Medical Center, New York, New York
Lisa Saiman
Affiliation:
NewYork-Presbyterian Hospital, New York, New York Columbia University Medical Center, New York, New York
E. Yoko Furuya
Affiliation:
NewYork-Presbyterian Hospital, New York, New York Columbia University Medical Center, New York, New York
David P. Calfee*
Affiliation:
Weill Cornell Medicine, New York, New York NewYork-Presbyterian Hospital, New York, New York
*
Address correspondence to David P. Calfee, MD, MS, Weill Cornell Medicine, 525 East 68th Street, Box 265, New York, NY 10065 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To assess antimicrobial prescriber knowledge, attitudes, and practices (KAP) regarding antimicrobial stewardship (AS) and associated barriers to optimal prescribing.

DESIGN

Cross-sectional survey.

SETTING

Online survey.

PARTICIPANTS

A convenience sample of 2,900 US antimicrobial prescribers at 5 acute-care hospitals within a hospital network.

INTERVENTION

The following characteristics were assessed with an anonymous, online survey in February 2015: attitudes and practices related to antimicrobial resistance, AS programs, and institutional AS resources; antimicrobial prescribing and AS knowledge; and practices and confidence related to antimicrobial prescribing.

RESULTS

In total, 402 respondents completed the survey. Knowledge gaps were identified through case-based questions. Some respondents sometimes selected overly broad therapy for the susceptibilities given (29%) and some “usually” or “always” preferred using the most broad-spectrum empiric antimicrobials possible (32%). Nearly all (99%) reported reviewing antimicrobial appropriateness at 48–72 hours, but only 55% reported “always” doing so. Furthermore, 45% of respondents felt that they had not received adequate training regarding antimicrobial prescribing. Some respondents lacked confidence selecting empiric therapy using antibiograms (30%), interpreting susceptibility results (24%), de-escalating therapy (18%), and determining duration of therapy (31%). Postprescription review and feedback (PPRF) was the most commonly cited AS intervention (79%) with potential to improve patient care.

CONCLUSIONS

Barriers to appropriate antimicrobial selection and de-escalation of antimicrobial therapy were identified among front-line prescribers in acute-care hospitals. Prescribers desired more AS-related education and identified PPRF as the most helpful AS intervention to improve patient care. Educational interventions should be preceded by and tailored to local assessment of educational needs.

Infect Control Hosp Epidemiol 2018;39:316–322

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 3 , March 2018 , pp. 316 - 322
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. An abstract summarizing the results of this study was presented as a poster at the national conference, IDWeek 2015 on October 8, 2015 in San Diego, California (abstract #204).

References

REFERENCES

1. Camins, BC, King, MD, Wells, JB, et al. Impact of an antimicrobial utilization program on antimicrobial use at a large teaching hospital: a randomized controlled trial. Infect Control Hosp Epidemiol 2009;30:931–938.Google Scholar
2. Ingram, PR, Seet, JM, Budgeon, CA, Murray, R. Point-prevalence study of inappropriate antibiotic use at a tertiary Australian hospital. Intern Med J 2012;42:719–721.CrossRefGoogle Scholar
3. Levin, PD, Idrees, S, Sprung, CL, et al. Antimicrobial use in the ICU: indications and accuracy—an observational trial. J Hosp Med 2012;7:672–678.Google Scholar
4. Patel, SJ, Oshodi, A, Prasad, P, et al. Antibiotic use in neonatal intensive care units and adherence with Centers for Disease Control and Prevention 12 Step Campaign to Prevent Antimicrobial Resistance. Ped Infect Dis J 2009;28:1047–1051.Google Scholar
5. Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51–e77.Google Scholar
6. Fridkin, S, Baggs, J, Fagan, R, et al. Vital signs: improving antibiotic use among hospitalized patients. MMWR Morb Mortal Wkly Rep 2014;63:194–200.Google Scholar
7. Dellit, TH, Chan, JD, Skerrett, SJ, Nathens, AB. Development of a guideline for the management of ventilator-associated pneumonia based on local microbiologic findings and impact of the guideline on antimicrobial use practices. Infect Control Hosp Epidemiol 2008;29:525–533.Google Scholar
8. Kisuule, F, Wright, S, Barreto, J, Zenilman, J. Improving antibiotic utilization among hospitalists: a pilot academic detailing project with a public health approach. J Hosp Med 2008;3:64–70.Google Scholar
9. Ruttimann, S, Keck, B, Hartmeier, C, Maetzel, A, Bucher, HC. Long-term antibiotic cost savings from a comprehensive intervention program in a medical department of a university-affiliated teaching hospital. Clin Infect Dis 2004;38:348–356.Google Scholar
10. Muto, CA, Blank, MK, Marsh, JW, et al. Control of an outbreak of infection with the hypervirulent Clostridium difficile BI strain in a university hospital using a comprehensive “bundle” approach. Clin Infect Dis 2007;45:1266–1273.Google Scholar
11. Fowler, S, Webber, A, Cooper, BS, et al. Successful use of feedback to improve antibiotic prescribing and reduce Clostridium difficile infection: a controlled interrupted time series. J Antimicrob Chemother 2007;59:990–995.Google Scholar
12. Hermsen, ED, Shull, SS, Puumala, SE, Rupp, ME. Improvement in prescribing habits and economic outcomes associated with the introduction of a standardized approach for surgical antimicrobial prophylaxis. Infect Control Hosp Epidemiol 2008;29:457–461.Google Scholar
13. Evans, RS, Pestotnik, SL, Classen, DC, et al. A computer-assisted management program for antibiotics and other anti-infective agents. N Engl J Med 1998;338:232–238.Google Scholar
14. Abbo, L, Sinkowitz-Cochran, R, Smith, L, et al. Faculty and resident physicians’ attitudes, perceptions, and knowledge about antimicrobial use and resistance. Infect Control Hosp Epidemiol 2011;32:714–718.Google Scholar
15. Joint Commission on Hospital Accreditation. APPROVED: new antimicrobial stewardship standard. Jt Comm Perspect 2016;36 1, 3, 4, 8.Google Scholar
16. Venugopalan, V, Trustman, N, Manning, N, Hashem, N, Berkowitz, L, Hidayat, L. Administration of a survey to evaluate the attitudes of house staff physicians towards antimicrobial resistance and the antimicrobial stewardship programme at a community teaching hospital. J Glob Antimicrob Resist 2016;4:21–27.Google Scholar
17. Chaves, NJ, Cheng, AC, Runnegar, N, Kirschner, J, Lee, T, Buising, K. Analysis of knowledge and attitude surveys to identify barriers and enablers of appropriate antimicrobial prescribing in three Australian tertiary hospitals. Intern Med J 2014;44:568–574.Google Scholar
18. Dyar, OJ, Pulcini, C, Howard, P, Nathwani, D, ESGAP (ESCMID Study Group for Antibiotic Policies). European medical students: a first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. J Antimicrob Chemother 2014;69:842–846.Google Scholar
19. Stach, LM, Hedican, EB, Herigon, JC, Jackson, MA, Newland, JG. Clinicians’ attitudes towards an antimicrobial stewardship program at a children’s hospital. J Pediatric Infect Dis Soc 2012;1:190–197.Google Scholar
20. Sanchez, GV, Hersh, A, Shapiro, DJ, Cawley, JF, Hicks, LA. Outpatient antibiotic prescribing among United States nurse practitioners and physician assistants. Open Forum Infect Dis 2016;3:ofw168.Google Scholar
21. Moote, M, Krsek, C, Kleinpell, R, Todd, B. Physician assistant and nurse practitioner utilization in academic medical centers. Am J Med Qual 2011;26:452–460.Google Scholar
22. U.S. Department of Labor. Occupational Outlook Handbook, 2016–17 Edition, Physician Assistants. Bureau of Labor Statistics website. http://www.bls.gov/ooh/healthcare/physician-assistants.htm. Published 2016. Accessed May 23, 2017.Google Scholar
23. Kaki, R, Elligsen, M, Walker, S, Simor, A, Palmay, L, Daneman, N. Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother 2011;66:1223–1230.Google Scholar
24. At UN, global leaders commit to act on antimicrobial resistance: Collective effort to address a challenge to health, food security, and development. Press release, United Nations High Level Meeting on Antimicrobial Resistance, New York, New York, September 21, 2016. United Nations website. http://www.un.org/pga/71/2016/09/21/press-release-hl-meeting-on-antimicrobial-resistance/. Published 2016. Accessed May 23, 2017.Google Scholar
25. White House. National action plan for combating antibiotic-resistant bacteria. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/pdf/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf. Published 2015. Accessed May 23, 2017.Google Scholar
Supplementary material: PDF

Salsgiver et al. supplementary material

Salsgiver et al. supplementary material 1

Download Salsgiver et al. supplementary material(PDF)
PDF 293.4 KB
Supplementary material: File

Salsgiver et al. supplementary material

Table S1

Download Salsgiver et al. supplementary material(File)
File 15.2 KB