Abstract
Background: Greece is among the European countries with the highest consumption of antibiotics, both in community and hospital settings, including last-line antibiotics, such as carbapenems. We sought to explore doctors’ perceptions, attitudes and practices towards the management of patients with multidrug-resistant organism (MDRO) infections after the implementation of an antimicrobial stewardship programme (ASP) in a tertiary academic hospital during the COVID-19 pandemic. Methods: A self-administered, internet-based questionnaire survey was completed by doctors of the University Hospital of Heraklion in Crete, Greece. Results: In total, 202 (59.1%) hospital doctors fully completed the questionnaire. Most of them agreed that the prospective audit and feedback ASP strategy is more effective and educational than the preauthorization ASP strategy. ASP implementation prompted most respondents to monitor the continuously evolving microbiological data of their patients more closely and affected them towards a multidisciplinary and personalised care of patients with infections caused by MDROs and towards a more rigorous implementation of infection prevention and control measures. The vast majority of participants (98.5%) stated that ASP must be continued and further developed during the COVID-19 pandemic. Conclusion: The ASP implementation in our hospital had a beneficial impact on doctors’ perceptions, attitudes and practices with regard to the management of infections due to MDROs.
Highlights
Excessive antimicrobial consumption and misuse are major problems worldwide and significantly contribute to antimicrobial resistance [1]
It consisted of 15 items, including close-ended, multiple choice and Likert-scale questions, divided as follows: 5 on demographics and practice-related information; 4 on previous and current experience with antimicrobial stewardship programme (ASP); 4 on perceptions related to the management of patients with multidrug-resistant organism (MDRO) infections after ASP implementation; and 2 on attitudes and practices towards the management of patients’ MDRO infections after ASP implementation
This study was the first to examine the perceptions, attitudes and practices of hospital doctors towards the management of hospitalised patients with infections caused by MDROs after the implementation of an ASP during the COVID-19 pandemic
Summary
Excessive antimicrobial consumption and misuse are major problems worldwide and significantly contribute to antimicrobial resistance [1]. An infectious diseases (ID) specialist and an ID fellow are being alerted by the hospital pharmacy upon prescription request for carbapenem and provide unsolicited in-person (“handshake”) consultation within 72 h for all patients for whom the treating doctors have prescribed carbapenem This approach includes a lack of prior authorization by the ASP members for carbapenem administration (i.e., treating doctors can prescribe a carbapenem for their patients without previous approval and even continue carbapenem administration despite a potentially opposite recommendation by the ASP members), the patient’s clinical examination by the ID specialist or ID fellow, review of the patient’s laboratory data and of all prescribed antimicrobials, and a subsequent daily, rounding-based, in-person approach to feedback by the ID doctors. The execution of the ASP has not been affected by the COVID-19 pandemic, since our hospital’s capacity has not been exceeded during the care of COVID-19 patients In this context, and after eleven months of ASP implementation, we sought to examine doctors’ perceptions, attitudes and practices towards the management of patients with multidrug-resistant organism (MDRO) infections. To the best of our knowledge, this was the first study of its kind conducted during the COVID-19 pandemic
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