Abstract
BackgroundAntibiotic stewardship interventions are being implemented across different healthcare settings. We report the findings of a global survey of healthcare professionals on the implementation of antibiotic stewardship programmes.MethodsLearners of a Massive Online Open Course (MOOC) on antibiotic stewardship were invited to complete an online survey on the core available organisational resources for stewardship. The categorical variables were analysed using chi-squared test, and Likert questions were analysed using an ordinal regression model. The p-values were considered as two-tailed. Significance was set at p-value of < 0.05.ResultsThe response rate was 55% (505/920), from 53 countries. The responders were 36% (182) doctors, 26% (130) pharmacists, 18% (89) nurses and 20% (104) other (researchers, students and members of the public). Post-graduate training in infection management and stewardship was reported by 56% of doctors compared with 43% (OR 0.59, 95%CI 0.35–1.00) nurses and 35% (OR 0.39, 95%CI 0.24–0.62) of pharmacists. Hospitals were significantly (83% in teaching hospitals, 79% in regional hospitals, p = < 0.01) more likely to have antibiotic policies, when compared to primary care. A surveillance mechanism for antibiotic consumption was reported in 58% (104/178) of teaching hospitals and 62% (98/159) of regional hospitals. Antimicrobial resistance, patient needs, policy, peer influence and specialty level culture and practices were deemed important determinants for decision-making.ConclusionPostgraduate training and support in antibiotic prescribing remains low amongst nurses and pharmacists. Whilst antibiotic policies and committees are established in most institutions, surveillance of antibiotic use is not. The impact of specialty level culture, and peer influence appears to be important factors of antibiotic prescribing.
Highlights
Antibiotic stewardship interventions are being implemented across different healthcare settings
The Massive Online Open Course (MOOC) was, and remains “open source”, meaning any person, including members of the public can complete the course and this was reflected in the survey respondents
Since we were primarily interested in the responses of healthcare professionals any respondents outside of this classification were grouped together as other (104/505, 21%), Table 1
Summary
Antibiotic stewardship interventions are being implemented across different healthcare settings. To address the global challenges of implementing antibiotic stewardship, in 2015, an international group of Charani et al Antimicrobial Resistance and Infection Control (2019) 8:34 researchers and clinicians developed a six-week Massive Open Online Course targeting a global audience [4]. The content of week five is based on the social science research investigating how contextual knowledge can be used to develop bespoke stewardship interventions in different settings [5]. This is important when considering the variation in resources, both financial and workforce across high, low, and middle income countries and how this affects stewardship [6]. The survey explored and what factors influenced the learners’ own antibiotic prescribing decision-making
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