Awareness of Bacterial Resistance to Antibiotics among Healthcare Providers in Sana’a City, Yemen

Abstract

Objectives: To assess the awareness of healthcare providers in Sana’a city of the most frequently antibiotic-resistant bacterial isolates encountered in clinical settings, the factors associated with the emergence of such resistance and the strategies to counteract antibiotic resistance. Methods: This cross-sectional study included 416 healthcare providers; namely, 167 physicians, 61 pharmacists and 188 nurses, from four public and two private hospitals in Sana’a. Data about demographics, awareness of the most frequently isolated antibiotic-resistant bacteria in clinical settings, the factors possibly associated with such resistance and the best strategies to counteract antibiotic resistance were collected using a pre-designed questionnaire. Data were then analyzed using suitable statistical tests. Results: The majority of healthcare providers were aware of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa as the two most frequently encountered bacterial species in clinical practice, with non-statistically significant differences in the awareness level among physicians, pharmacists and nurses. However, a statistically significant difference was found among healthcare providers regarding their awareness of the most possible factors contributing to antibiotic resistance. In this regard, pharmacists were significantly more aware of the contribution of the extensive use of newer generations of antibiotics (P = 0.030), inappropriate prescribing of antibiotics (P = 0.010) and use of antibiotics without prescription (P = 0.045) to the emergence and spread of antibiotic resistance than physicians and nurses. On the other hand, physicians and nurses were significantly more aware of the role of reducing the length of hospital stay (P = 0.005), limiting the use of medical instrumentation (P = 0.036), use of narrow-spectrum antibiotics (P = 0.005), surveillance for antibiotic resistance (P = 0.004), development of infection control policies and procedures (P <0.001) and consultation with infectious disease specialists (P = 0.010) as key strategies to minimize the emergence of antibiotic-resistant bacteria compared to pharmacists. Moreover, nurses showed significantly higher awareness of the use of narrow-spectrum antibiotics (P = 0.005) and surveillance of antibiotic resistance (P = 0.003) as key strategies to reduce the emergence and spread of antibiotic resistance. Conclusions: There is a discrepancy in the awareness of Yemeni healthcare providers’ of the most frequently encountered antibiotic-resistant bacteria in clinical practice, the factors possibly contributing to such resistance and the key strategies to counteract it. Therefore, continuing medical education of physicians, pharmacists and nurses is recommended to keep them updated on antibiotic resistance and the best strategies and approaches to its containment. In addition, there is a need for the development of infectious disease protocols for hospitals to optimize the selection and treatment with antibiotics, to reduce side effects and costs and to minimize the development of antibiotic resistance.