The knowledge, attitudes and practices of doctors regarding antibiotic resistance at a tertiary care institution in the Caribbean

Tamara Thompson,Stephen Johnson,Ingrid Tennant,Livingston White,Loraine Cook,Camille-Ann Thoms-Rodriguez,Alison Nicholson,Jasper Barnett,Lundie Richards

doi:10.1186/s13756-018-0315-3

Abstract

BackgroundAntibiotic resistance (ABR) is a serious threat that requires coordinated global intervention to prevent its spread. There is limited data from the English-speaking Caribbean.MethodsAs part of a national programme to address antibiotic resistance in Jamaica, a survey of the knowledge, attitudes and antibiotic prescribing practices of Jamaican physicians was conducted using a 32-item self-administered questionnaire.ResultsOf the eight hundred physicians targeted, 87% responded. The majority thought the problem of resistance very important globally (82%), less nationally (73%) and even less (53%) in personal practices. Hospital physicians were more likely to consider antibiotic resistance important in their practice compared to those in outpatient practice or both (p < 0.001). Composite knowledge scores were generated and considered good if scored > 80%, average if 60–79% and poor if < 60%. Most had good knowledge of factors preventing resistance (83%) and resistance inducing potential of specific antibiotics (59%), but only average knowledge of factors contributing to resistance (57%). Knowledge of preventative factors was highest in females (p = 0.004), those with postgraduate training (p = 0.001) and those > four years post graduation (p = 0.03). Empiric therapy was often directed by international guidelines and cultures were not routinely done. Limited laboratory and human resources were identified as challenges.ConclusionPhysicians in this study were aware of the problem of ABR, but downplayed its significance nationally and personally. These results will guide a national antibiotic stewardship programme.

Highlights

Antibiotic resistance (ABR) is a serious threat that requires coordinated global intervention to prevent its spread
Hospital physicians were more likely to consider ABR very important in their practice than outpatient-based, or physicians who practiced in both areas (65% vs. 39% and 35% respectively, p < 0.001)
This study found that only 21% of physicians would deescalate therapy, while a 2010 single-centre Jamaican study showed that only 7.7% practiced deescalation [33]

Summary

Introduction

Antibiotic resistance (ABR) is a serious threat that requires coordinated global intervention to prevent its spread. There is limited data from the English-speaking Caribbean. Antibiotic resistance (ABR) has emerged as a significant threat to the quality of health care in the twenty-first century [1]. This, combined with decreased production of new antimicrobial agents, has precipitated a global crisis with the emergence of bacteria resistant to most antibiotics [2–5]. Of the over 20 countries in the English speaking Caribbean, data on antibiotic resistance are limited largely to reports from Jamaica, Trinidad and Tobago and Barbados [8–13]. This is concerning, as the Caribbean is a popular destination especially for North. A 2009 study in a university-affiliated hospital in Kingston, Jamaica showed that resistance among Gram-positive organisms was much lower than among Gram-negative organisms [16]

Methods

Results

Discussion

Conclusion