scholarly journals Perception, Attitude, and Confidence of Physicians About Antimicrobial Resistance and Antimicrobial Prescribing Among COVID-19 Patients: A Cross-Sectional Study From Punjab, Pakistan

2022 ◽  
Vol 12 ◽  
Author(s):  
Khezar Hayat ◽  
Zia Ul Mustafa ◽  
Muhammad Nabeel Ikram ◽  
Muhammad Ijaz-Ul-Haq ◽  
Irum Noor ◽  
...  

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.

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 798
Author(s):  
Rojjares Netthong ◽  
Keivan Ahmadi ◽  
Ros Kane

Antimicrobial resistance (AMR) is a threat to achieving the United Nation’s (UN) sustainable development goals (SDGs). The behavior of stakeholders has directly influenced the extent of AMR and understanding underpinning knowledge and attitudes is an important step towards understanding these behaviors. The aim of this study was to develop and validate a novel questionnaire, utilizing the theory of Appreciative Inquiry, to measure knowledge and attitudes around antibiotic resistance amongst community pharmacists throughout Thailand. A survey tool was developed using the Appreciative Inquiry theory, and was piloted in a non-probability sample of practicing community pharmacists. Descriptive and inferential statistics were applied and the tool validated, using a three-step psychometric validation process. A total of 373 community pharmacists participated in the study. The survey tool was found to be valid and reliable. The “Knowledge” domain of the survey tool showed an acceptable level of reliability (Cronbach’s alpha 0.64); while the “Attitude” domain showed an excellent reliability level (Cronbach’s alpha 0.84). This new survey tool has been designed to measure attitudes and knowledge of antibiotic resistance by utilizing the Discovery phase of Appreciative Inquiry theory amongst community pharmacists in Thailand. This survey tool has the potential to be used by other researchers across different settings.


2018 ◽  
Vol 103 (2) ◽  
pp. e2.43-e2
Author(s):  
Michelle Kirrane ◽  
Rob Cunney ◽  
Roisin McNamara ◽  
Ike Okafor

Appropriate choice of empiric antibiotic therapy, in line with local guidelines, improves outcome for children with infection, while reducing adverse drug effects, cost, and selection of antimicrobial resistance. Data from national point prevalence surveys showed compliance with local prescribing guidelines at our hospital was suboptimal. A team with representatives from the pharmacy, microbiology and emergency departments collaborated with prescribers to improve the quality of empiric antibiotic prescribing. The project aim was, using the ‘Model for Improvement’, to ensure ≥90% of children admitted via the Emergency Department (ED) and commenced on antibiotic therapy, have a documented indication and a choice of therapy in line with local antimicrobial guidelines.MethodResults of weekly audits of the first ten children admitted via ED and started on antibiotics were fed back to prescribers. Front line ownership techniques were used to develop ideas for change, including; regular antibiotic prescribing discussion at Monday morning handover meeting, antibiotic ‘spot quiz’ for prescribers, updates to prescribing guidelines (along with improved access and promotion of prescribing app), printed ID badge guideline summary cards, reminders and guideline summaries at point of prescribing in ED.Collection of audit data initially proved challenging, but was resolved through a series of rapid PDSA cycles. Initial support from ED consultants and other ED staff facilitated establishment of the project. Presentation of weekly run charts to prescribers fostered considerable support among consultants and non-consultant doctors (NCHDs). We saw a shift in perspective from ‘how is your project going?’ to ‘How are we doing?’.ResultsDocumentation of indication and guideline compliance increased from a median of 30% in December 2014/January 2015 to 100% consistently from February 2015 to the present. It is felt that a change in approach to antimicrobial prescribing is now embedded in our hospital culture as this improvement has remained constant through three NCHD changeovers. A comparison of 2014 Antimicrobial expenditure to 2015 figures shows a reduction in expenditure of €101,078.44.ConclusionThis project has inspired other departments to develop local QIPs and has encouraged the surgical teams to lead their own audits in antimicrobial stewardship. An improvement in other areas of antimicrobial prescribing has also been noted e.g. documentation of review date.The initiative has been shared with other hospitals throughout Ireland via presentations at the National Patient Safety Conference, Antimicrobial Awareness day and the Irish Antimicrobial Pharmacist’s Group meeting. It has also been shared at both European and international conferences. The project was a shortlisted finalist for a national healthcare excellence award and has been rolled out as part of a national quality improvement collaborative.


2015 ◽  
Vol 30 (2) ◽  
Author(s):  
Simone Ambretti ◽  
Carlo Gagliotti ◽  
Francesco Luzzaro ◽  
Paolo Malacarne ◽  
Angelo Pan ◽  
...  

The aim of antimicrobial resistance surveillance is to monitor temporal trends and provide clinicians with data to define empirical treatment protocols. The surveillance methods adopted in different settings can be significantly different and, therefore, no reference can be made to a single set of standards. This paper outlines the main features of analysis and reporting of antimicrobial resistance data according to the guidelines issued by the US Clinical and Laboratory Standards Institute, and the surveillance systems adopted in Europe. In this article the strengths and weaknesses of the various types of analyses will be discussed highlighting the critical aspects to be taken into account in surveillance data reporting.


2020 ◽  
Vol 31 (3) ◽  
pp. 190-197 ◽  
Author(s):  
Miguel Fernández-Huerta ◽  
María J Barberá ◽  
Judit Serra-Pladevall ◽  
Juliana Esperalba ◽  
Xavier Martínez-Gómez ◽  
...  

Antibiotic resistance in Mycoplasma genitalium has been emerging in Europe. Also, discrepancies on the management and treatment of sexually transmitted infections may have distinctly influenced the prevalence of antimicrobial resistance among European countries. This comprehensive review of the literature published between 2012 and 2018 updates antimicrobial resistance data in M. genitalium in Europe. Overall, macrolide resistance is rapidly increasing in this region, where many countries are exceeding 50%. The limited data regarding fluoroquinolone resistance estimate a prevalence of 5% (interquartile range, 5–6%). The study supports the need to conduct representative and well-defined surveillance on antimicrobial resistance in M. genitalium at both local and European levels. Also, further investigations on new promising antibiotics are required to fight against M. genitalium that may soon become untreatable.


Author(s):  
Kanika Sharma ◽  
Baitullah Abdali ◽  
Payal Kesharwani ◽  
Neha Mittal ◽  
Hemlata Bisht

Antibiotics have been regarded as one of the major discoveries of the 20th century. But the problem that came attached with is the rise of antibiotic resistance in hospitals and communities. The genetic makeup of microbes has benefitted from man's overuse of antibiotics to exploit every source of resistance genes and means of horizontal gene transmission to give rise to various mechanisms of resistance. Alexander Fleming upon accepting the 1945 Nobel Prize in Medicine said “It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them. There is a danger that an ignorant man may easily under dose himself and by exposing his microbes to non lethal quantities of the drug and make them resistant”. This review presents the multifaceted aspects of antibiotic resistance development, history, superbug and superresiatance and resistance data observed over the past years with an overt conclusion showing undeniable methods to overcome the discussed problem, glaringly striking that it is time to act.


2019 ◽  
Vol 4 ◽  
pp. 140
Author(s):  
Quentin J. Leclerc ◽  
Nichola R. Naylor ◽  
Alexander M. Aiken ◽  
Francesc Coll ◽  
Gwenan M. Knight

Background: Antibiotics are most often prescribed empirically, meaning that they are used to treat infection syndromes prior to identification of the causative bacteria and their susceptibility to antibiotics. The effectiveness of antibiotic therapies is now compromised by the emergence and spread of antibiotic-resistant bacteria. Guidelines on empiric antibiotic therapy are a key component of effective clinical care for infection syndromes, as treatment needs to be informed by knowledge of likely aetiology and bacterial resistance patterns. Methods: We used open-access antimicrobial resistance (AMR) surveillance datasets, including the newly available ATLAS dataset from Pfizer, to derive a composite index of antibiotic resistance for common infection syndromes. Results: We developed a framework that integrated data on antibiotic prescribing guidelines, aetiology of infections, access to and cost of antibiotics, with antibiotic susceptibilities from global AMR surveillance datasets to create an empirical prescribing index. The results are presented in an interactive web app to allow users to visualise underlying resistance rates to first-line empiric antibiotics for their infection syndromes and countries of interest. Conclusions: We found that whilst an index for empiric antibiotic therapy based on resistance data can technically be created, the ATLAS dataset in its current form can only inform on a limited number of infection syndromes. Other open-access AMR surveillance datasets (ECDC Surveillance Atlas, CDDEP ResistanceMap and WHO GLASS datasets) are largely limited to bacteraemia-derived specimens and cannot directly inform treatment of other infection syndromes. With improving data availability on international rates of AMR and better understanding of infection aetiology, our approach may prove useful for informing empiric prescribing decisions in settings with limited local AMR surveillance data. Syndrome-level resistance could be a more clinically relevant measure of resistance to inform on the appropriateness of empiric antibiotic therapies at the country-level.


2018 ◽  
Vol 39 (8) ◽  
pp. 986-988 ◽  
Author(s):  
Heather L. Young ◽  
Katherine C. Shihadeh ◽  
Alisha A. Skinner ◽  
Bryan C. Knepper ◽  
Jeffrey Sankoff ◽  
...  

AbstractSmartphones are increasingly used to access clinical decision support, and many medical applications provide antimicrobial prescribing guidance. However, these applications do not account for local antibiotic resistance patterns and formularies. We implemented an institution-specific antimicrobial stewardship smartphone application and studied patterns of use over a 1-year period.


Author(s):  
Tasha Santiago-Rodriguez

Antibiotic-resistance has long been associated with the use and abuse of antibiotics. However, increasing evidence is suggesting that antibiotic-resistance is in fact a phenomenon that has been occurring in natural environments for thousands and possibly millions of years. With the expansion of the microbiome field, it is now possible to characterize antibiotic-resistance genes altogether in different samples, including the human gut. This has also enabled the characterization of ancient human gut microbiomes, which also include antibiotic-resistance genes. Mummified gut remains represent a unique opportunity to characterize the microbiome and antibiotic-resistance genes prior the antibiotic-therapy era. Surprisingly, mummies from the Inca and Italian nobility cultures showed to possess antibiotic-resistance-like genes similar to modern-day antibiotic-resistance genes conferring resistance to beta-lactams, sulfa, quinolones and vancomycin, just to mention a few examples. This is intriguing as it further supports that antibiotic-resistance began in the environment and was transferred to the human gut by means that remain to be investigated and are a matter of ongoing speculation.


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