Antibiotic Awareness Campaigns Research Articles

Occurrence and Antimicrobial Resistance Profile of Escherichia coli in Poultry from Gusau metropolis, Nigeria

The increment in misuse of antimicrobial agents in the treatment of human and animal diseases has made bacterial organisms such as E. coli become resistant to many available antibiotics. This study investigates the presence of E. coli in chicken within the studied area. A cross-sectional study was conducted to determine the presence and antimicrobial resistance profile of E. coli in chicken within Gusau metropolis Zamfara state, Nigeria. A total of 289 cloacal swabs were collected from 40 broilers, 219 layers and 30 local chickens. Bacterial culture, phenotypic characterization, antibiotic susceptibility test were conducted. The overall prevalence of E. coli based on phenotypic identification was 22.1 % (64/289). The prevalence of E. coli based on the different chicken types was 20 % (8/40), 23.3 % (51/219) and 16.7 % (5/30) for broilers, layers and local chickens respectively. There was no statistically significant association between the isolate of E. coli and chicken type (p = 0.0987; df = 2). Antibiotic susceptibility test revealed 87.5% and 85.9 % resistance to Amoxicillin-clavulanate and Imipenem respectively, 76.6 % resistance to Cefuroxime, 60.9 % to Erythromycin, 51.6 % to Cefexime, 53.1% to Cefotaxime and 48.4 % Azithromycin. However, 31.3 % were resistant to Levofloxacin, 37.5 % to Ofloxacin, 42.2 % to Ceftriaxone, 45.3 % to Ciprofloxacin and 42.2 % to Gentamicin. In conclusion the study revealed the prevalence of E. coli in poultry from Gusau Metroplis to be 22.1 % (64/289) and antibiotic resistance awareness campaign is recommended to be employed by relevant agency.

Maternal knowledge and prescribing practices of antibiotics for childhood infections: a cross-sectional survey in Jordan

This article aims to assess the knowledge and practices of Jordanian mothers regarding antibiotic consumption by their children. A questionnaire was distributed to mothers during hospital visits in February-May 2020. Questions were on socio-demographics; knowledge of antibiotic indications/complications; and prescribing practices. A total of 1926 mothers participated. Most mothers were aware that antibiotics are not indicated for viral infections (72.0%), and that abuse leads to complications like antibiotic resistance (82.1%). However, their knowledge regarding antibiotic complications was not satisfactory particularly complications of obesity (11.7%), caries (29.9%), and allergy (43.4%). The most important clinical indications for antibiotics were perceived to be otitis media (89.8%), and sore throat (44.4%). A proportion of 21.7% admitted self-prescribing, significantly among families of ≤2 children, and poor antibiotic knowledge (p<0.01). Lower antibiotic knowledge scores were impacted mostly by grandparents who self-prescribe antibiotics (p<0.01). Jordanian mothers show satisfactory knowledge of pediatric antibiotic consumption, however, their knowledge of complications is not sufficient. Antibiotic self-prescribing is identified mainly in families with lower income and less antibiotic knowledge, therefore these families should be identified and targeted in antibiotic awareness campaigns.

The Effects of Health Education on the Awareness of Antimicrobial Resistance Among High School Students in Riyadh, Saudi Arabia During 2023: A Quasi-experimental Study.

Introduction Antimicrobial resistance (AMR) is a major health threat, recently declared a crisis by the WHO, and recognized as one of the top 10 threats to global health. One of the strategies to curb AMR is interventional education to raise awareness. Therefore, this study evaluated the impact of interventional education on awareness of antimicrobial resistance among high school students in Riyadh, Saudi Arabia. Methods This was a quasi-experimental study that included 120 high school students as a control group and 120 students as the experimental group. It used a questionnaire pre- and post-educational intervention, which wasa lecture by trained healthcare workers. Pearson's Chi-square test and ANOVA were used to assess the effects of the intervention, and the p-value was set at <0.05 for significance. Results Over half (53.4%) of the controls reported no prior exposure to an antibiotic awareness campaign, compared to 46.6% in the intervention (experimental) group. Half of the participants in both groups were without a family relative who works in the healthcare sector. Almost half (51.2%) in the intervention group used antibiotics compared to 48.2% of controls; 53.3% in the control group reported self-medication compared to 46.7% in the intervention group. We found a statistically significant increase in the overall mean scores regarding knowledge of antibiotics resistance before and after the education intervention in the control group (p<0.001) and intervention group(p<0.001).Post-intervention, there was a significant reduction in the mean scores of misbeliefs about antibiotic use (p<0.001). We found an improvement in the perception scores toward AMR and antibiotic resistance post-educational intervention (P=0.008), and the perception difference remained significant between the two study groups (p=0.002). Conclusion These findings showed that interventional education effectively raises awareness, knowledge, and perceptions toward AMR. Therefore, public health, medical, and scientific professionals in Saudi Arabia are urged to emphasize education to fight AMR, in addition to other strategies.

Does antibiotic awareness campaigns exposure decrease intention to demand antibiotic treatment? Testing a structural model among parents in Western Australia.

Antimicrobial resistance (AMR) is one of the key public health concerns the world is facing today. The effect of antibiotic awareness campaigns (AACs) on consumer behaviour has been documented in the literature with mixed results. Understanding the mechanism for how AACs affect target populations is vital in designing effective and tailored campaigns. Using structural equation modelling our study examined the relationships among people's exposure to antibiotic awareness campaigns, knowledge of AMR prevention, AMR risk perception, and intention to seek antibiotic treatment. This study also tested the moderating effect of anxiety and societal responsibility on preventing AMR, and on their intention to demand antibiotic treatment mediated by knowledge of AMR prevention and risk-perception. Primary data was generated using an online survey of 250 Western Australian parents. We tested our hypotheses using reliability and validity tests and structural equation modelling. Our results show that exposure to AACs alone may not be enough to change parental intention to demand antibiotic prescription for their children. Parental risk perception of AMR and parental anxiety affect intention to demand antibiotics, and the view that AMR is a social responsibility has a moderating effect on intention to demand antibiotics. These factors could be considered and combine messaging strategies in designing future antibiotic awareness campaigns.

A Process Evaluation of the Isfahan Antibiotic Awareness Campaign: Developing Engagement on Antimicrobial Resistance.

One of the most prominent global health threats is antibiotic resistance, leading to infection treatment failure. The first Iranian antibiotic awareness week campaign was initiated to improve the prudent use and wise prescription of antibiotics. The Isfahan antibiotic awareness campaign was held from November 30 to December 6, 2019, among two targeted populations; the general population and health-care workers by Isfahan University of Medical Sciences. In this campaign held in the main squares, streets, and a city's referral hospital, various educational methods were used to aware and sensitize the general population and medical staff about antibiotics and microbial resistance. These methods include face-to-face training, brochures, advertisement posters and billboards around the city, educational videos, social media messages, retraining for medical doctors and medical specialists, and interviewing in the Islamic Republic of Iran Broadcast. Two hundred and twenty general practitioners, medical specialists, and residents participated in two retraining educational conferences in Al-Zahra Hospital, Isfahan, Iran. The mean score satisfaction of the two conferences was three from four. Nearly 2000 of the general population were under face-to-face educational programs whom after that, 83.6% had the correct answer to the questions around antimicrobial awareness. This campaign was an excellent experience as a pilot study with appealing issues. Further, activities are required to improve engagement with the target population and determine the impact of this campaign on antibiotic consumption and prescription behavior among the public and health-care professionals.

P47 Infographics about antibiotics: making facts accessible

BackgroundPublic misconceptions about antibiotic use persist despite the efforts of antibiotic awareness campaigns. These campaigns have often followed a top-down approach and have not sought input from the public. Communities need to see antibiotic campaign messages as relevant, accessible and important in order to have an influence on health-seeking behaviour and antibiotic use.ObjectivesTo develop a series of evidenced-based infographics (EBIs) on antibiotic use for common infections in children and to evaluate their effectiveness at increasing parents' understanding of antibiotic use and antibiotic resistance.MethodsThere were three phases to this research. In Phase 1 we set out to identify and summarize scientific evidence for the use of antibiotics for three common infections in children (sore throat, acute cough and otitis media). Phase 2 focused on co-design of a series of prototype EBIs for each infection in focus groups with parents of young children and graphic designers, to test the face and content validity. Phase 3 tested the feasibility of EBIs in increasing parents' understanding about antibiotic use and the perceived relevance of antibiotic resistance in an online survey.ResultsWe iteratively co-produced 10 prototype EBIs. Parents found the evidence displayed in the EBIs novel and relevant to their families. Parents did not favour EBIs that were too medically focused. The way the information was displayed influenced their understanding. Parents preferred one health message per EBI. We included eight EBIs in a national survey of parents (n = 998). EBIs improved knowledge by more than a third across the board (34%, IQR 20%–46% P<0.001). Respondents confirmed that EBIs were novel and potentially useful, corroborating our focus group findings.ConclusionsCo-designed EBIs have the potential to succinctly change parents' perceptions about antibiotics for acute respiratory tract infections in children. Further research should test EBIs in real-world settings to assess their reach as a potential public-facing intervention.

Consumption of systemic antibiotics in the Russian Federation in 2017–2021

Objective. To assess level and the structure of systemic antibiotic consumption in Russia over the period 2017 to 2021. Materials and Methods. Data were collected and analysed in compliance with the standard protocol of the World Health Organization Regional Office for Europe by the means of ATC/DDD methodology for J01 group – antibacterials for systemic use. Consumption was calculated for outpatients and inpatients separately as a number of DDDs per 1000 inhabitants per day (DID) for the main classes of antibiotics and the agents with the highest or the most diverse consumption levels for the given period of time, and was based on the data of wholesale purchases and public tenders. Results. Antibiotic consumption in Russia in 2017, 2018, 2019, 2020, and 2021 was 16.6 DID, 14.3 DID, 14.8 DID, 19 DID, and 15.7 DID respectively. Penicillins, macrolides and lincosamides, and quinolones had the highest levels of consumption in outpatients. Prominent increase in outpatient consumption of antibacterials in 2020 was related to three agents: azithromycin, levofloxacin and ceftriaxone. Cephalosporins (mainly III–V generations), quinolones and penicillins had the highest levels of consumption in inpatients. Hospital consumption of meropenem, tigecycline, and vancomycin increased and amikacin and ciprofloxacin decreased over the duration of the study. Conclusions. Levels of systemic antibiotic consumption in Russia for the period 2017 to 2019 were relatively low and consistent with the average means for European Union and European Economic Area countries. The steep increase in consumption in 2020 was probably due to the wide use of antibiotics for the management of COVID-19 patients. The results of the study can be of value for the development of targeted national antibiotic stewardship programs and awareness campaigns as well as for the analysis of trends of emergence and spread of antibiotic resistance.

Knowledge, Attitude, and Practices of Community Pharmacists on Antibiotic Resistance and Antimicrobial Stewardship in Lusaka, Zambia

Background: Antimicrobial/Antibiotic Resistance (AMR) is among the major threats to global health. Due to limited information on the subject matter in Zambia, we assessed the knowledge, attitude, and practices of community pharmacists on AMR and Antimicrobial Stewardship (AMS). Materials and Methods: We conducted a descriptive cross-sectional study among 144 randomly selected community pharmacists through a structured questionnaire. Data were analysed using Statistical Package for Social Sciences version 22 at a 95% confidence level. The Fisher’s exact test was used to determine the relationship between sociodemographic factors of community pharmacists and their knowledge, attitude, and practices on antibiotic resistance and antimicrobial stewardship. Results: A response rate of 91% (n = 144) was achieved. Interestingly, 93.8% had good knowledge while 67% had positive attitudes regarding AMR and AMS. Conversely, 75% of the community pharmacists demonstrated poor practices towards AMR and AMS. The majority of the CPs 69.4% agreed that antibiotic resistance is a public health problem. The majority of the CPs 57.6% agreed that the appropriate use of antibiotics improves patient care and outcome. Of concern, (32.6%) of CPs rarely collaborated with other healthcare workers in activities that promote infection control and AMS. Also, the majority of the CPs did not take part in antibiotic awareness campaigns nor educate the public on antibiotic use and over 80% of CPs regularly issued antibiotics without a prescription. Conclusions: Even though community pharmacists had good knowledge and positive attitudes, they demonstrated poor practices that require quick educational interventions. As most CPs issue antibiotics without a prescription, this should be highlighted as a major policy issue on AMR and should be addressed by the Government. There is a need to promote AMS sensitization programmes among community pharmacists.

Impact of targeted educational intervention towards public knowledge and perception of antibiotic use and resistance in the state of Perak, Malaysia

BackgroundAntibiotic resistance is a major public health concern, accelerated by antibiotic overuse. Inadequate knowledge among the public has been associated with inappropriate use of antibiotics. This study determined the impact of a self-developed educational leaflet for addressing specific knowledge gaps in antibiotic use among the public.MethodsThis was an experimental study conducted at five hospitals and 20 primary health care clinics in the state of Perak. Adults over 18 years of age were recruited using sequential sampling. The first phase of data collection consisted of a pre-intervention assessment, an educational session, and an immediate post-intervention assessment. Each educational session was conducted by trained pharmacists and lasted approximately 15 min for each participant. A two-week post-intervention assessment was then conducted via a phone call to re-assess the participants using the same questionnaire.ResultsOut of 300 questionnaires distributed, 234 were completed for our study. The mean age of participants was 40.7 ± 14.6 years old. Most of the respondents were female (143, 61.1%), Malay (162, 69.2%), and had tertiary education (162, 69.2%). A mean score was generated for each domain, with knowledge towards antibiotic resistance: 2.83 ± 1.28 pre-intervention, 3.76 ± 0.62 immediate post-intervention, and 3.67 ± 0.78 two-weeks post-intervention (total score: 4.00); knowledge towards antibiotic use: 2.03 ± 1.56 pre-intervention, 4.56 ± 1.46 immediate post-intervention, and 4.32 ± 1.48 two-weeks post-intervention (total score: 6.00); perception towards antibiotic use: 2.83 ± 1.38 pre-intervention, 4.25 ± 1.06 immediate post-intervention, and 4.22 ± 1.02 two-weeks post-intervention (total score: 5.00). Significant improvement in the mean scores were found before and after intervention in all domains (p < 0.001).ConclusionThe educational leaflet was able to address salient knowledge gaps in the participants and remained sustainable over a two-week follow-up. Thus, its inclusion into future antibiotic awareness campaigns should be encouraged.

Knowledge, Attitude, and Practice on Antibiotics and Its Resistance: A Two-Phase Mixed-Methods Online Study among Pakistani Community Pharmacists to Promote Rational Antibiotic Use.

Antibiotic resistance (ABR) is an emerging global threat to public health. Substantial evidence has indicated that community pharmacists (CPs) can play a critical role in managing the ever-increasing threat of antibiotic resistance. This study aimed to determine the knowledge, attitude, and practices of CPs (n = 180) towards antibiotics and antibiotic resistance as well as to improve the rational use of antibiotics. A two-phase mixed-methods (quantitative and qualitative) online study was conducted in Pakistan from August 2019 to March 2020 by using validated questionnaires and semi-structured interview data. Different statistical methods were used to tabulate the quantitative data, whereas inductive thematic analysis was conducted to categorize themes from the qualitative data and to draw conclusions. Approximately 64.4% of the CPs were male (mean: 29–33 years old). Overall, CPs had good knowledge of and were familiar with multidrug-resistant organisms and their roles in ABR (65.6%, median = 1, and IQR = 1), although their knowledge was poor in differentiating some antibiotic groups with their respective ABR patterns (31.1%, median = 1, and IQR = 1). Most CPs have a positive attitude towards antibiotics, with most (90.0%) identifying ABR as a critical issue in public health (median = 1 and IQR = 0). Overall, CPs’ practices towards antibiotics were somewhat acceptable, where they leaned towards educating patients about the rational use of antibiotics (52.8%, median = 1, and IQR = 1). The two main themes discovered (antibiotics and counseling of patients) were related to self-medication, while educational intervention is the main subtheme. ABR is multifactorial, with subthemes related to budget, time constraints, incompetent staff, the absence of CPs, the lack of training, and the enforcement of laws and regulations being the needs of the hour in Pakistan. Effective antibiotic stewardship programs, patient education, and awareness campaigns about antibiotics and ABR along with training of the CPs are important factors that have to be addressed in a timely manner.

Educational intervention material toward public knowledge and perception in antibiotic awareness – An evaluation of the impact in Perak, Malaysia

Background: Antibiotic awareness campaigns have been conducted in Malaysia since 2015. This study aimed to evaluate the impact of self-developed educational material towards public knowledge and perception of oral antibiotic use and resistance. Methods and materials: A quasi-experimental study was conducted at 5 hospitals and 20 primary health clinics in Perak state from January to February 2019. The first phase of data collection consisted of pre-education evaluation, educational session and immediate post-education evaluation. The second phase involved post-education evaluation via phone calls. The questionnaire was developed and validated by researchers. The education material was developed with references from WHO and Ministry of Health (MOH) Malaysia. It consisted of antibiotic resistance knowledge (total score of 4), antibiotic use knowledge (total score of 6) and antibiotic use perception (total score of 5). The educational sessions were conducted by trained pharmacists for approximately 15 minutes followed by 2 weeks post-education evaluation. Results: 300 questionnaires were distributed with 234 completed the evaluation. The respondents scored total mean 2.83 (±1.28) in antibiotic resistance knowledge during pre-education, 3.76 (±0.62) immediately post-education and 3.67 (±0.78) 2 weeks post-education (p < 0.001). In antibiotics use knowledge, they obtained total mean 2.03 (±1.56) during pre-education, 4.56 (±1.46) immediately post-education and 4.32 (±1.48) 2 weeks post-education (p < 0.001) while the total mean scores for perception towards antibiotic use were 2.83 (±1.38), 4.25 (±1.06) and 4.22 (±1.02) respectively (p < 0.001). Initially, 160 (68.7%) respondents understood that antibiotic resistance happened when the antibiotic lost its ability to cure bacterial infection. 2 weeks post-education, 212 correct respondents (90.6%) were obtained (p < 0.001). During pre-education, 85 respondents (36.3%) disagreed on taking inadequate dose antibiotic for treatment, which increased to 166 correct respondents (70.9%) 2 weeks post-education (p < 0.001). 62 (26.5%) respondents believed that individual can contribute to prevent antibiotic resistance during pre-education with a significant increment to 162 respondents (69.2%) 2 weeks post-education (p < 0.001). Conclusion: Educational intervention material was able to improve public knowledge and perception. This should be encouraged in antibiotic awareness campaign.

World Antibiotic Awareness Week and European Antibiotic Awareness Day, November 2018: An analysis of the impact of Twitter activity

IntroductionInternational antibiotic awareness and stewardship campaigns use social media to disseminate campaign materials. Analysis of campaigns during 2016 and 2017 identified a wide range of hashtags in use, potentially leading to confusion and dilution of the campaign message. This study aimed to examine the impact of different hashtags on the dissemination of information during European Antibiotic Awareness Day and World Antibiotic Awareness Week, November 2018. MethodsTweets were prospectively extracted using Followthehashtag and analysed in Excel and R (14 400 tweets by 5 899 tweeters, with 60 222 retweets). Descriptive analysis and multivariable logistic regression analyses were adjusted for potential confounders. ResultsThere was a positive association between retweets received and inclusion of media, hashtag(s), mention of other tweeter(s), and number of followers. There was hashtag drift (e.g. the unofficial #WAAW2018 hashtag was used more frequently than the official campaign #WAAW18 hashtag). Analysis of five popular hashtags from the European and worldwide campaigns found a positive association between retweets and the unofficial hashtag #WAAW2018 and the long-established #AntibioticGuardian hashtag. #AntibioticResistance (another official hashtag) was the most frequently used hashtag but did not have a consistent positive association with retweets. Analysis of the contribution of tweeters – tweeters, retweeters, and mentions of tweeters – demonstrated 32 534 accounts in total, 95% of which tweeted and/or retweeted, the great majority being retweeters. ConclusionThis study demonstrates the breadth of participation in international antibiotic awareness campaigns, but also the need for clarity about campaign hashtags, and the need to search beyond official hashtags when evaluating the impact of a campaign.

Antibiotic Use and Antibiotic Resistance: Public Awareness Survey in the Republic of Cyprus

We aimed to assess the knowledge and understanding of antibiotic use and resistance in the general population of Cyprus, in order to inform future antibiotic awareness campaigns with local evidence. Cross-sectional survey following the methodology of the “Antibiotic resistance: Multi-country public awareness survey” of the World Health Organization, during December 2019–January 2020. A total of 614 respondents participated: 64.3% were female and most were aged 35–44 years (33.2%) or 25–34 years (31.8%). One-third had used antibiotics >1 year ago and 91.6% reported receiving advice on appropriate use from a medical professional. Despite high awareness on correct use of antibiotics, lack of knowledge was noted for specific indications, where approximately one-third believed that viral infections respond to antibiotics and 70.7% lack understanding of how antibiotic resistance develops. Higher education graduates exhibited significantly higher knowledge rates. As high as 72.3% were informed about “antibiotic resistant bacteria” from healthcare professionals or social media. Most agreed on the usefulness of most suggested actions to address antibiotic resistance, with higher proportions acknowledging the role of prescribers. Up to 47% could not identify their role in decreasing antibiotic resistance. Our study provides local evidence to inform future efforts in a country characterized by high antibiotic consumption rates.

Impact of Hospital Acquired Infection and Antibiotic Resistance Awareness Campaign on Knowledge Attitude and Practices of Medical Undergraduates in a Tertiary Care Teaching Hospital, India

Introduction: Healthcare professionals have an important role in tackling the growing menace of Hospital Acquired Infections (HAI) and Antibiotic Resistance (ABR). Regular trainings imparted early in career can result in better understanding of these crucial issues. Aim: To identify the baseline Knowledge Attitude and Practices (KAP) of 5th semester MBBS undergraduate students of a University Medical College in Rajasthan, India, and to determine the changes in these parameters after the implementation of a vigorous “HAI and ABR Awareness campaign”. Materials and Methods: This prospective interventional study involved 86, 5th semester MBBS undergraduate students. The study instrument was a preformed pretested 30 item self-administered questionnaire. The study intervention included a series of lectures, role plays, poster competition; and an audio-visual quiz. The performance of individual participants before and after the intervention was then statistically analysed with Microsoft Excel and software Statistical Package for the Social Sciences (SPSS) version 20. Results: The pre-intervention overall KAP score of each student was found to be poor in 17.4%, average in 61.6%, and excellent in 20.9% in study participants. Post-intervention grades were found to be poor, average, and excellent in 1.1%, 8.14%, and 90.7% study participants, respectively. A statistically significant decrease in the percentage of students with poor grade and a significant increase in those with excellent grade were observed. Conclusion: There is a need for suitable amendments in current MBBS curriculum to include modules which comprehensively address the core issues of ABR, HAIs and Antimicrobial Stewardship (AMS). This would help to bring out attitude and behavioural changes in students at the very grass-root level.

Characteristics of a Nationwide Voluntary Antibiotic Resistance Awareness Campaign in India; Future Paths and Pointers for Resource Limited Settings/Low and Middle Income Countries.

Antibiotic resistance has reached alarming proportions globally, prompting the World Health Organization to advise nations to take up antibiotic awareness campaigns. Several campaigns have been taken up worldwide, mostly by governments. The government of India asked manufacturers to append a ‘redline’ to packages of antibiotics as identification marks and conducted a campaign to inform the general public about it and appropriate antibiotic use. We investigated whether an antibiotic resistance awareness campaign could be organized voluntarily in India and determined the characteristics of the voluntarily organized campaign by administering a questionnaire to the coordinators, who participated in organizing the voluntary campaign India. The campaign characteristics were: multiple electro–physical pedagogical and participatory techniques were used, 49 physical events were organized in various parts of India that included lectures, posters, booklet/pamphlet distribution, audio and video messages, competitions, and mass contact rallies along with broadcast of messages in 11 local languages using community radio stations (CRS) spread all over India. The median values for campaign events were: expenditure—3000 Indian Rupees/day (US$~47), time for planning—1 day, program spread—4 days, program time—4 h, direct and indirect reach of the message—respectively 250 and 500 persons/event. A 2 min play entitled ‘Take antibiotics as prescribed by the doctor’ was broadcast 10 times/day for 5 days on CRS with listener reach of ~5 million persons. More than 85%ofcoordinators thought that the campaign created adequate awareness about appropriate antibiotic use and antibiotic resistance. The voluntary campaign has implications for resource limited settings/low and middle income countries.

1879. A 20/20 Vision: Successful Integration of a Prescribing Dashboard for Outpatient Antimicrobial Stewardship to Target 20% Reduction by the Year 2020

BackgroundAt least 30% of antibiotics prescribed in the ambulatory setting are unnecessary, including high rates of overuse for acute respiratory infections (ARI). We designed and evaluated whether a multifaceted outpatient stewardship program leveraging multidisciplinary stakeholder engagement, education tools, and an innovative prescribing dashboard decreased antibiotic prescribing in ARI.MethodsIn November 2017, the Carolinas HealthCare Outpatient Antimicrobial Stewardship Empowerment Network (CHOSEN) launched an antibiotic awareness campaign in over 150 ambulatory practices in the Charlotte metropolitan area, reaching over one million patients. The campaign included online and in-person tools for patients and providers, targeted education at meetings, and social and mass media exposure. In March 2018, a provider level prescribing dashboard was introduced to target inappropriate antibiotic prescribing in ARI (acute sinusitis, nonsuppurative otitis media, nonbacterial pharyngitis, URI, cough, allergy, and influenza). Data were collected for family medicine (FM), internal medicine (IM), urgent care (UC) and pediatric medicine (PM); 10% and 20% relative reduction targets (years 2019 and 2020, respectively) were set for each service line. We compared pre (April 2016–March 2018) vs. post (April 2018–March 2019) intervention prescribing rates (calculated as the number of encounters with antibiotics vs. total) as rate ratios and used segmented regression models to assess change over time.ResultsThere were 1,001,335 pre and 448,390 post-intervention encounters. Postintervention prescribing rates (antibiotics per 100 encounters) decreased for all service lines, FM (49.4 to 39.3), IM (49.7 to 41.2), UC (49.8 to 44.4), and PM (40.6 to 36.1) vs. pre-intervention (all rate ratios, P ≤ 0.01). All service lines met the target 2019 10% reduction goals. Post-implementation, FM and IM showed immediate decreases in prescribing (figure). After an initial increase, UC showed a significant month-to-month decrease (figure).ConclusionIntegration of a prescribing dashboard within a multifaceted antibiotic awareness campaign reduced inappropriate outpatient antibiotic prescribing for ARI and achieved interim targets consistent with 2020 reduction goals. Disclosures All Authors: No reported Disclosures.

Qualitative and quantitative evaluation of the use of Twitter as a tool of antimicrobial stewardship

IntroductionSocial media networks have transformed the sources of information, including health information. In particular, the microblogging service Twitter has been used as a learning tool in the field of medicine as well as a tool for disease surveillance and outbreak management. As antimicrobial resistance is one of the biggest concerns of public health, we aimed to review how Twitter is being used as a tool for antimicrobial stewardship (AMS). MethodsWe used the software Kampal Social® to collect, analyze and monitor tweets from the whole Twitter network to assess the activity that takes place about antibiotics. The study was carried out in three phases: data acquisition, during which we collected data over a six-month period (from 21 September 2016 to 8 February 2017) by monitoring selected users, hashtags and keywords that we knew to be related to AMS; data cleansing, which involved identifying users who were not related to the topic, thus creating a new collection process to remove those users and add newly discovered ones; and, finally, data acquisition and analysis (From 1 April 2017 to 7 March 2018), during which we collected data using the new users obtained in the cleansing phase. We qualitatively characterized the most influential users, we analysed the use of hashtags and the flow of information (the most retweeted users and the global network formed by all the users). ResultsUsing the tool Kampal Social®, and after a cleansing phase to remove irrelevant information, we worked with a dataset of 1,765,388 tweets. Studying the qualitative characterization of the top-ten influencers, we found that most of them are institutional users, but individual users, such as physicians, and an important medical journal also appeared. Regarding hashtags, ‘#antibiotics’ was the one with the most occurrences. Hashtags follow a regular distribution over time, with some defined peaks connected to important dates and reports about antibiotics. As for the flow of information, we obtained a rather dense network of interconnections formed by all the users who had sent a message, which means that a strong relation exists between the different organizations, professionals and users in general. ConclusionsInstitutions, medical journals, physicians and pharmacists are key opinion leaders in the topic of antibiotics, so they must incorporate social media into their communication strategy to spread the AMS message. More evidence is needed regarding the optimal method of communication to spread information throughout the general population. The development of tools capable of collecting and querying large amounts of Twitter data helped us to assess the impact of antibiotic awareness campaigns and to gain an idea of how Twitter is being used to spread the message about AMS.

How to improve antibiotic awareness campaigns: findings of a WHO global survey

IntroductionWe aimed to examine the characteristics of antibiotic awareness campaigns (AAC) conducted on a national or regional level since 2010.MethodsIn October 2016, the WHO invited stakeholders involved in the planning...

Parents' perceptions of antibiotic use and antibiotic resistance (PAUSE): a qualitative interview study.

BackgroundThere remains public misconception about antibiotic use and resistance. Preschool children are at particular risk of receiving unnecessary antibiotics because they commonly present in primary care and many childhood infections are self-limiting.ObjectivesThe aim of our study was to explore parents’ perceptions and understanding of antibiotic use and resistance in the context of their young child with an acute respiratory tract infection (RTI) and to explore strategies parents would find acceptable to minimize antibiotic resistance for their families.MethodsSemi-structured interviews were conducted with 23 parents of preschool children who recently had an acute RTI across greater Oxfordshire, UK (2016–17 winter). We explored their beliefs about antibiotics, understanding of antibiotic resistance and views on current public antibiotic awareness campaigns at the time. Thematic analysis was used to analyse the data.ResultsParents had a sense of optimism and considered their families to be at low risk of antibiotic resistance because their families were ‘low users’ of antibiotics. Very few parents considered antibiotic resistance as a possible harm of antibiotics. Parents thought they were acting morally responsibly by following campaign messages. They wanted future campaigns to have a relevant, accessible message for families about the impact of antibiotic resistance.ConclusionsFuture communication about the potential impact of unnecessary antibiotic use and antibiotic resistance needs to focus on outcomes that parents of young children can relate to (e.g. infection recurrence) and in a format that parents will engage with (e.g. face-to-face dissemination at playgroups and parent/child community events) to make a more informed decision about the risks and benefits of antibiotics for their child.

Risk factors for antimicrobial use in veal calves and the association with mortality

The intensive use of antimicrobials in the veal industry is heavily criticized, but drivers for antimicrobial usage (AMU) are still poorly understood. The industry fears that a drastic reduction in AMU would increase mortality, creating an unacceptable welfare issue. The objectives of the present study were to identify risk factors for AMU and to explore the relationship between AMU and mortality. A retrospective cohort study was performed on the antimicrobial registration data from the largest Belgian veterinary veal practice. The data set contained 295 production cycles from 78 farms, representing 146,014 calves and 8 veal companies (also called integrations). The average AMU was 32.3 defined daily dose animal per year (standard deviation: 11.04), of which 76.2% was administered orally and 23.8% parentally. The AMU remained stable between 2014 and 2016 with only a slight, but significant increase in total AMU between 2015 (31.0 defined daily dose animal per year, standard deviation: 10.5) and 2016 (35.1, 10.8). Use of almost all antimicrobial classes decreased over 2014 to 2016; however, use of long-acting macrolides, doxycycline, and aminosides increased significantly. Analysis identified breed (higher use in beef calves compared with dairy and crossbreeds), month of arrival (lower use when arrived in April or May compared with winter months), and veal company as risk factors. The veal company not only significantly affected total AMU, but also affected the majority of the antimicrobial classes. Additionally, breed differences were present for oxytetracycline, colistin, and classic macrolides, and a month effect was present for doxycycline only. These data illustrate that this veterinary practice realized a reduction of 46% in total AMU and of 96% in critically important antibiotics (fluoroquinolones, cephalosporins of the third and fourth generation) compared with the Belgian benchmark from 2007 to 2009. Replacement of critically important drugs by an increased use of long-acting macrolides is worrisome. Mortality risk was very low compared with benchmarks referenced internationally and did not increase with decreasing AMU. Use of trimethoprim-sulfonamides was a risk factor, whereas use of oxytetracycline was a protective factor for mortality. The absence of a relationship with mortality at the current levels of AMU suggests that a further rational reduction is possible. Attention should be paid to consider different AMU benchmarks for different breeds and to include the veal company as a target for antibiotic awareness campaigns.