Knowledge about sepsis among training-grade doctors

Abstract

Prescribing of antibiotics, often in the empirical setting, frequently falls on training-grade or junior doctors, who are often the least experienced in this. Indeed, improving the knowledge base of training-grade doctors or senior medical students through education has been identified as one of the key measures to improve antibiotic prescribing behaviour. We undertook two descriptive questionnaire- and interview-based surveys (1999 and 2003) of prescribing training-grade doctors in a teaching hospital in north-east Scotland to determine their knowledge level regarding various sepsis definitions, sources of local information used when prescribing an antimicrobial, and awareness of the cost difference between intravenous and oral antibiotics. A total of 55 junior doctors in a large teaching hospital participated in the survey in 1999 and 78 participated in 2003. Between the two audits, which were conducted 4 years apart, several initiatives were introduced to improve the education and support related to antibiotic prescription. There has been a significant improvement in doctors' knowledge regarding various sepsis definitions, whether the infection was hospital or community acquired, empirical choice, dose, route of administration and monitoring of the antibiotic, and options for drug hypersensitivity. More training-grade doctors (approximately 29%) used the desired locally derived sepsis protocol, which guides the prescriber through sepsis recognition. There was no significant improvement in the percentage of doctors who recognized that parenteral antimicrobials were more expensive (approximately 10-fold) than oral antimicrobials (63.7% in 1999, 64.2% in 2003). Overall, there was a significant improvement in doctors' understanding of sepsis and knowledge of the source of information that they utilized to select the antibiotic of choice, although the majority did not acknowledge the price difference between intravenous and oral forms of antibiotics.