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Lajunen TJ, Sullman MJM, Baddal B, Tekeş B, Apostolou M. Antibiotics Knowledge, Attitudes and Behaviours among the Population Living in Greece and Turkey. Antibiotics (Basel) 2023; 12:1279. [PMID: 37627699 PMCID: PMC10451639 DOI: 10.3390/antibiotics12081279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Antimicrobial resistance is one of the largest threats to public health worldwide. As the inappropriate use of antibiotics is one of the leading causes of antibiotic resistance, it is important to have an understanding of the public's knowledge, attitudes and behaviours towards antibiotics and antimicrobial resistance. The present study investigated the knowledge, attitudes and behaviours towards antibiotics among the public living in Greece and Turkey using an online cross-sectional survey, with social media advertising (e.g., Facebook) and snowball sampling. In total, 709 individuals completed the survey (Greece n = 309, Turkey n = 400), with an average age of 34.2 (SD = 13.1) and 40.5 (SD = 14.7), respectively. In Greece, 49.4% of the participants were female, and in Turkey, this figure was 62.4%. The Greek respondents reported that obtaining antibiotics without a prescription was easier (52.6% reported "easy or very easy") than the Turkish (35.6% reported "easy or very easy") respondents did. This study reveals that Greek citizens were more educated and knowledgeable about antibiotics (58.5% of Greeks and 44.2% of Turks identified antibiotics correctly), their effects (20.9% of Greeks and 26.3% of Turks agreed with wrong statements about antibiotics) and the risks of antibiotic resistance, compared to those from Turkey. On the other hand, the Greek respondents were more prone to use leftover antibiotics or to give them to someone else later (p < 0.001). The findings of this study indicate that Greece and Turkey, both countries with high rates of antibiotic usage, exhibit distinct variations in their knowledge, attitudes, and perceptions concerning antibiotic use and antibiotic resistance. Effective countermeasures such as public campaigns should be targeted according to the population and those areas of knowledge, attitudes and behaviours in which the main shortcomings lie.
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Affiliation(s)
- Timo J. Lajunen
- Department of Psychology, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
| | - Mark J. M. Sullman
- Department of Social Sciences, School of Humanities and Social Sciences, University of Nicosia, Nicosia CY-1700, Cyprus; (M.J.M.S.); (M.A.)
| | - Buket Baddal
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia 99138, Cyprus;
| | - Burcu Tekeş
- Department of Psychology, Başkent University, Ankara 06790, Turkey;
| | - Menelaos Apostolou
- Department of Social Sciences, School of Humanities and Social Sciences, University of Nicosia, Nicosia CY-1700, Cyprus; (M.J.M.S.); (M.A.)
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Manolitsis I, Feretzakis G, Katsimperis S, Angelopoulos P, Loupelis E, Skarmoutsou N, Tzelves L, Skolarikos A. A 2-Year Audit on Antibiotic Resistance Patterns from a Urology Department in Greece. J Clin Med 2023; 12:jcm12093180. [PMID: 37176622 PMCID: PMC10178956 DOI: 10.3390/jcm12093180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE The high incidence of urinary tract infections (UTIs), often in nosocomial environments, is a major cause of antimicrobial resistance (AMR). The dissemination of antibiotic-resistant infections results in very high health and economic burdens for patients and healthcare systems, respectively. This study aims to determine and present the antibiotic resistance profiles of the most common pathogens in a urology department in Greece. METHODS During the period 2019-2020, we included 12,215 clinical samples of blood and urine specimens that tested positive for the following pathogens: Escherichia coli, Enterococcus faecium, Enterococcus faecalis, Proteus mirabilis, Klebsiella pneumoniae, or Pseudomonas aeruginosa, as these are the most commonly encountered microbes in a urology department. RESULTS The analysis revealed a 22.30% mean resistance rate of E. coli strains with a 76.42% resistance to ampicillin and a 54.76% resistance rate to ciprofloxacin in the two-year period. It also showed an approximately 19% resistance rate of P. mirabilis strains and a mean resistance rate of 46.205% of K. pneumoniae strains, with a decreasing trend during the four semesters (p-value < 0.001), which presented an 80% resistance rate to ampicillin/sulbactam and 73.33% to ciprofloxacin. The resistance to carbapenems was reported to be 39.82%. The analysis revealed a 24.17% mean resistance rate of P. aeruginosa with a declining rate over the two-year period (p-value < 0.001). The P. aeruginosa strains were 38% resistant to fluoroquinolones and presented varying resistance against carbapenems (31.58% against doripenem and 19.79% against meropenem). Regarding the Enteroccocal strains, a 46.91% mean resistance was noted for E. faecium with 100% resistance to ampicillin, and a 24.247% mean resistance rate for E. faecalis strains that were 41% resistant to ciprofloxacin. Both types showed 100% sensitivity to linezolid. CONCLUSIONS The dissemination of antibiotic-resistant pathogens poses the need to implement surveillance programs and, consequently, to develop strategies to prevent the emergence of such pathogens in order to optimize patient outcomes.
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Affiliation(s)
- Ioannis Manolitsis
- Second Department of Urology, Sismanogleio General Hospital, 15126 Marousi, Greece
| | - Georgios Feretzakis
- School of Science and Technology, Hellenic Open University, 26335 Patras, Greece
- Department of Quality Control, Research and Continuing Education, Sismanogleio General Hospital, 15126 Marousi, Greece
| | | | | | | | | | - Lazaros Tzelves
- Second Department of Urology, Sismanogleio General Hospital, 15126 Marousi, Greece
| | - Andreas Skolarikos
- Second Department of Urology, Sismanogleio General Hospital, 15126 Marousi, Greece
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Papadimou D, Malmqvist E, Ancillotti M. Socio-cultural determinants of antibiotic resistance: a qualitative study of Greeks' attitudes, perceptions and values. BMC Public Health 2022; 22:1439. [PMID: 35902816 PMCID: PMC9333897 DOI: 10.1186/s12889-022-13855-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Antibiotic resistance is a complex phenomenon heavily influenced by social, cultural, behavioural, and economic factors that lead to the misuse, overuse and abuse of antibiotics. Recent research has highlighted the role that norms and values can play for behaviours that contribute to resistance development, and for addressing such behaviours. Despite comparatively high antibiotic consumption in Greece, both at the community and healthcare level, Greeks have been shown to be relatively aware of the connection between antibiotic overuse and antibiotic resistance. This suggests that Greeks’ non-judicious use cannot simply be explained by lack of awareness but may relate to other factors specific to Greek society. The present study aimed to explore attitudes, perceived norms, and values in relation to antibiotics, in order to improve understanding of socio-cultural determinants of antibiotic resistance in Greece. Methods Data were collected through online focus group discussions in 2021. Twenty Greeks were recruited through purposive sampling, aiming for as heterogeneous groups as possible regarding gender (12 women, 8 men), age (range 21–55, mean 33), and education level. Interview transcripts were analysed inductively using thematic content analysis. Results Participants considered antibiotic overconsumption as a consolidated habit influenced by ease of access, social expectations and, more generally, cultural practices. While critical of such norms and practices, participants opposed stewardship measures that would prioritize the societal interest in maintaining antibiotic effectiveness over individual needs. Participants considered responsibility for antibiotic resistance to be shared by the whole society, but the role of government actors and health professionals as well as of food producers was emphasized. Notably, scepticism about the prospect of effectively managing antibiotic resistance in Greece was commonly expressed. Conclusions The study makes explicit attitudes, perceived norms and values that, besides limited awareness, may contribute to non-judicious antibiotic use in Greece. These socio-cultural determinants of antibiotic resistance warrant further research and should be considered when designing measures aimed to mitigate this problem. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13855-w.
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Affiliation(s)
- Dimitrios Papadimou
- The Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3, SE 413 90, Gothenburg, Sweden
| | - Erik Malmqvist
- Centre for Antibiotic Resistance Research (CARe) and Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Renströmsgatan 6, SE 41255, Gothenburg, Sweden
| | - Mirko Ancillotti
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, SE-751 22, Uppsala, Sweden.
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Karakonstantis S, Kalemaki D. Antimicrobial overuse and misuse in the community in Greece and link to antimicrobial resistance using methicillin-resistant S. aureus as an example. J Infect Public Health 2019; 12:460-464. [PMID: 30981652 DOI: 10.1016/j.jiph.2019.03.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/19/2019] [Accepted: 03/24/2019] [Indexed: 10/27/2022] Open
Abstract
Both antimicrobial consumption and antimicrobial resistance are very high in Greece, ranking among the highest of Europe. The link between antimicrobial consumption and resistance is well-known. Here, we discuss the reasons of antimicrobial overuse in Greece in the community (such as self-medication, dispersion of antibiotics by pharmacies without prescription, over-prescription by physicians, patient expectations and liability pressure) and we explore the misuse of antibiotics for common community infections. Furthermore, we discuss how such overuse/misuse can drive antimicrobial resistance, using methicillin-resistance in Staphylococcus aureus as an example. S. aureus is one of the pathogens with high rates of resistance in Greece. Comparing the rate of antimicrobial susceptibility to non-beta lactams between methicillin-resistant and methicillin-sensitive S. aureus we highlight the antibiotics that have the potential to drive methicillin-resistance through co-selection. Based on the above we identify targets for intervention in order to reduce antimicrobial overuse/misuse in the community in Greece.
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Affiliation(s)
- Stamatis Karakonstantis
- Department of Internal Medicine, General Hospital of Heraklion "Venizeleio-Pananeio", Leoforos Knossou, Heraklion, 71409, Greece.
| | - Dimitra Kalemaki
- General Medicine, University Hospital of Heraklion, Heraklion, 71410, Greece
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Maltezou HC, Dedoukou X, Asimaki H, Kontou I, Ioannidou L, Mitromara K, Theodoridou K, Katerelos P, Theodoridou M. Consumption of antibiotics by children in Greece: a cross-sectional study. Int J Pediatr Adolesc Med 2017; 4:108-111. [PMID: 30805511 PMCID: PMC6372488 DOI: 10.1016/j.ijpam.2017.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 11/19/2022]
Abstract
Background Greece is among the European countries with the highest consumption of antibiotics. Objectives To study the rates and characteristics of consumption of antibiotics in the community by children in Greece. Methods Questionnaire-based study of parents of hospitalized children. Results A total of 549 children were studied; 247 (45%) received at least one course of antibiotics the previous year (mean number of antibiotic courses the past year: 1.9), including 427 (91.8%) following examination by a pediatrician, 6 (1.3%) following phone consultation, 2 (0.4%) following suggestion by a pharmacist and 2 (0.4%) as self-medication. Prevalent reasons for antibiotic consumption were acute otitis media (AOM) (27.3%), pharyngotonsillitiss (25.4%), and bronchitis (17.8%). Amoxicillin-clavulanate was the prevalent antibiotic for pharyngotonsillitis, urinary tract infection (UTI) and skin infection (30.5%, 35.7% and 36.4% of cases, respectively), amoxicillin for AOM and pneumonia (32.3% and 36.4% of cases, respectively), and clarithromycin for bronchitis (27.7%). We found 84.3%, 81.9%, 64.3%, 63.7%, and 50% of parents reporting treatment consisted with the national guidelines for AOM, pneumonia, UTI, skin infection, and pharyngotonsillitis, respectively. In the multivariate analysis, an age of 1-5 years and asthma were significantly associated with a higher probability for antibiotic consumption. Conclusions Antibiotic consumption of children in Greece is mainly driven by pediatricians. Continuing medical education is expected to further improve antibiotic prescription practices by pediatricians.
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Affiliation(s)
- Helena C. Maltezou
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
- Corresponding author. Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, 3-5 Agrafon Street, Athens, Greece.
| | - Xanthi Dedoukou
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Hara Asimaki
- First Department of Pediatrics, University of Athens, “Aghia Sophia” Children's Hospital, Athens, Greece
| | - Ioanna Kontou
- First Department of Pediatrics, University of Athens, “Aghia Sophia” Children's Hospital, Athens, Greece
| | - Loukia Ioannidou
- First Department of Pediatrics, University of Athens, “Aghia Sophia” Children's Hospital, Athens, Greece
| | - Konstantina Mitromara
- First Department of Pediatrics, University of Athens, “Aghia Sophia” Children's Hospital, Athens, Greece
| | - Kalliopi Theodoridou
- First Department of Pediatrics, University of Athens, “Aghia Sophia” Children's Hospital, Athens, Greece
| | - Panos Katerelos
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Maria Theodoridou
- First Department of Pediatrics, University of Athens, “Aghia Sophia” Children's Hospital, Athens, Greece
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