Abstract
Background. Gram negative antibiotic resistance is increasing worldwide as both carbapenem-resistant enterobacteriaceae (CREs) and Enterobacteriaceae producing extended spectrum ß-lactamases (ESBLs) become more common.Objective. We analyzed clinicians’ knowledge regarding resistant gram-negative organisms with respect to infection control practices, prescribing practices and assessment of their patients’ risk for resistant infections.Design. Online survey.Participants. Target population included clinicians who prescribe antibiotics i.e., medical doctors and mid-level practitioners, at three Massachusetts hospitals.Methods. Questionnaires were sent to 3 Tufts-affiliated teaching hospitals to assess level of knowledge and elucidate perceptions about gram-negative resistance.Results. We received 434 responses from 3332 non-infectious disease clinicians (13%) surveyed at the three hospitals. 51.1% of clinicians correctly scored 50% or greater on the knowledge questions. Internal medicine clinicians had higher knowledge scores than non-internal medicine clinicians (62% vs 45%; OR = 1.67, p = 0.02). Clinicians within three years of training had higher scores than those with more than 10 years of training (64.3% vs 44%; OR = 2.3, p = 0.002). Clinicians with fewer years since training and those with higher knowledge scores were more likely to appropriately consider certain patients at risk for resistant infections (p < 0.05). 54.4% of clinicians were very concerned about gram-negative antibiotic resistance. 64.6% of clinicians felt comfortable de-escalating antibiotics as cultures are available.Conclusion. We found overall low knowledge scores and much variability in the way clinicians assess whether certain patient populations are at risk for antibiotic resistance. Internal medicine clinicians and those with fewer years since completion of their training scored higher and more appropriately considered patients at risk for resistance. The majority of clinicians are concerned about gram-negative resistance and indicated they would de-escalate antibiotic therapy if they had susceptibility information. These results will help focus and target our teaching and awareness-raising strategies.
Highlights
Gram negative antibiotic resistance is increasing worldwide as both carbapenem-resistant enterobacteriaceae (CREs) and Enterobacteriaceae producing extended spectrum ß-lactamases (ESBLs) become more common
While infection control practices have been shown to decrease the spread of resistance during outbreaks (Munoz-Price et al, 2010), given the limited antibiotic choices to treat these infections, awareness and prevention by clinicians is imperative in preventing further spread of this epidemic
Given health care practitioners are at the cornerstone of antibiotic prescribing, caring for patients admitted to the hospital, and assessing their risk for resistant infections, it is imperative to understand clinicians’ baseline knowledge, prescribing practices, and risk assessment strategies
Summary
Gram negative antibiotic resistance is increasing worldwide as both carbapenem-resistant enterobacteriaceae (CREs) and Enterobacteriaceae producing extended spectrum ß-lactamases (ESBLs) become more common. Clinicians with fewer years since training and those with higher knowledge scores were more likely to appropriately consider certain patients at risk for resistant infections (p < 0.05). The majority of clinicians are concerned about gram-negative resistance and indicated they would de-escalate antibiotic therapy if they had susceptibility information. These results will help focus and target our teaching and awarenessraising strategies. There is a need to better understand the general knowledge and practice of healthcare practitioners in relation to the more recent and rapidly evolving gram-negative resistance problem This information can be used so antimicrobial stewardship teams and infection disease specialists may identify knowledge gaps and inappropriate practices to better focus their educational efforts. With improved education regarding appropriate risk assessment and prescribing practice, the further development of resistance may be slowed
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