Abstract
Background: Patients with coronavirus disease 2019 (COVID-19) could experience multiple coinfections, and judicial antimicrobials, including antibiotics, is paramount to treat these coinfections. This study evaluated physicians’ perception, attitude, and confidence about antimicrobial resistance (AMR) and antimicrobial prescribing in patients with COVID-19. Methods: A self-administered and validated online questionnaire comprised of six sections was disseminated among physicians working in public sector hospitals in Punjab, Pakistan, using the convenience sampling method from April to May 2021. The study also assessed the validity and reliability of the study questionnaire using exploratory factor analysis and Cronbach’s alpha. In addition, the descriptive and inferential statistics present survey results. Results: A total of 387 physicians participated in this study. The study showed that the questionnaire demonstrated good internal consistency (Cronbach’s alpha = 0.77). Most physicians (n = 221, 57.1%) believed that AMR is a considerable problem in Pakistan. Less than a quarter of respondents (n = 91, 23.5%) consulted with local antibiotic resistance data to prescribe antibiotics in COVID-19 patients. However, the respondents were confident to select a suitable antibiotic (n = 229, 59.2%). More than three-quarters of the respondents believed that advice from a senior colleague ( n = 336, 86.8%), infectious disease (ID) physician (n = 315, 81.4%), and implementing antimicrobial stewardship programs (ASPs) could facilitate appropriate prescribing of antibiotics in COVID-19 patients. Multivariate logistic regression revealed that physicians with more than 10 years of experience had higher odds of consulting local guidelines for antibiotic therapy (OR, 4.71 95% CI: 1.62–13.73, p = 0.004) than physicians with less than 5 years of experience. Similar trends were found for consulting national guidelines and local resistance data to select an empiric antibiotic therapy. Conclusion: AMR-related awareness was optimal among physicians. Only a few physicians looked up local antibiotic resistance data before prescribing antibiotics to COVID-19 patients empirically. The significant approaches advised by physicians to reduce AMR risk among COVID-19 patients were the implementation of ASPs combined with advice from ID physicians.
Highlights
Coronavirus disease 2019 (COVID-19) has invaded nearly every continent globally, with around 261 million laboratoryconfirmed cases and 5.2 million deaths as of November 29, 2021 (WHO, 2021)
The present study demonstrates a high awareness about antimicrobial resistance (AMR) among physicians and reported a positive attitude to minimize the AMR risk among COVID-19 patients
Most physicians were confident to select the appropriate antibiotic with the correct dose, route, and duration
Summary
Coronavirus disease 2019 (COVID-19) has invaded nearly every continent globally, with around 261 million laboratoryconfirmed cases and 5.2 million deaths as of November 29, 2021 (WHO, 2021). During the first wave of COVID-19, around 5% of cases develop the critical disease with multiple organ injuries and consequent deaths in almost half of these cases (Samudrala et al, 2020). The severity of the disease among hospitalized patients may worsen the condition, leading to over-prescription of antibiotics and antimicrobial resistance (AMR) (Beović et al, 2020). Patients with coronavirus disease 2019 (COVID-19) could experience multiple coinfections, and judicial antimicrobials, including antibiotics, is paramount to treat these coinfections. This study evaluated physicians’ perception, attitude, and confidence about antimicrobial resistance (AMR) and antimicrobial prescribing in patients with COVID-19
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