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Krockow EM, Cheng KO, Maltby J, McElroy E. Existing terminology related to antimicrobial resistance fails to evoke risk perceptions and be remembered. COMMUNICATIONS MEDICINE 2023; 3:149. [PMID: 37880476 PMCID: PMC10600229 DOI: 10.1038/s43856-023-00379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global healthcare threat promoted by all use of antibiotics. Hence, reducing overuse of antibiotics is essential. The necessary behaviour change relies on effective public health communication, but previous information campaigns-while showing some successes-have fallen short in generating a lasting increase of public awareness. A potential reason for this is AMR-related terminology, which has been criticised as inconsistent, abstract and difficult to pronounce. We report the first empirical test of word memorability and risk association for the most frequent AMR-related health terms. METHODS Across two surveys sampling 237 US and 924 UK participants, we test people's memory for and the risk they associate with six AMR-related terms and thirty-four additional health risk terms (e.g., cancer). Participants also rate the terms on different linguistic dimensions including concreteness, familiarity, processing fluency and pronounceability. RESULTS Our findings suggest that existing AMR-related health terms-particularly "AMR" and "Antimicrobial resistance"-are unsuitable for public health communication, because they score consistently low on both memorability and risk association. Out of the AMR terms, "Antibiotic resistance" and-to a lesser extent-"Drug-resistant infections" perform best. Regression analyses suggest that linguistic attributes (e.g., familiarity, processing fluency, pronounceability) are predictors of the terms' risk association. CONCLUSIONS Our findings highlight an urgent need to rename AMR with a memorable term that effectively signals the existential threat of AMR and thereby motivates a change in antibiotic use. The success of the revised term is likely to depend, at least partially, on its linguistic attributes.
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Affiliation(s)
- Eva M Krockow
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK.
| | - Kate O Cheng
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - John Maltby
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK
| | - Eoin McElroy
- School of Psychology, Ulster University, Coleraine, UK
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2
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Krockow EM, Patel S, Roland D. Decision Challenges for Managing Acute Paediatric Infections: Implications for Antimicrobial Resistance. Antibiotics (Basel) 2023; 12:antibiotics12050828. [PMID: 37237731 DOI: 10.3390/antibiotics12050828] [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: 03/13/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Overprescribing of antibiotics in paediatrics accounts for a significant proportion of inappropriate antibiotic use in human healthcare, thereby contributing to the global health emergency of antimicrobial resistance. Antimicrobial stewardship efforts are complicated by the unique social dynamics in paediatric healthcare, with a specific challenge being the prominent role of parents and carers who act as intermediaries between prescribers and paediatric patients. In this Perspective article concentrating on healthcare of the United Kingdom, we describe this complicated interplay of different decision stakeholders (patients, parents and prescribers), outline four dimensions of decision challenges (social, psychological, systemic and specific diagnostic and treatment challenges) and provide a number of theory-based strategies for supporting different stakeholders during the decision process, ultimately with the aim of improving antimicrobial stewardship. Key decision challenges for patients and carers include limited knowledge and experience of managing infections, which were exacerbated during the COVID-19 pandemic and frequently result in health anxiety and inappropriate health-seeking behaviours. Challenges for medical prescribers span societal pressures from prominent patient litigation cases, cognitive biases, and system pressures to specific diagnostic problems (e.g., age limitations of current clinical scoring systems). Strategies for mitigating decision challenges in paediatric infection management will need to include a range of context- and stakeholder-specific actions, including improvements of integrated care and public health education as well as better clinical decision tools and access to evidence-based guidelines.
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Affiliation(s)
- Eva M Krockow
- School of Psychology and Vison Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Sanjay Patel
- Department of Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton SO16 6YD, UK
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester LE1 5WW, UK
- SAPPHIRE Group, Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, UK
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3
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Attitudes towards Use of High-Importance Antimicrobials—A Cross-Sectional Study of Australian Veterinarians. Antibiotics (Basel) 2022; 11:antibiotics11111589. [DOI: 10.3390/antibiotics11111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2022] Open
Abstract
The timely implementation of antimicrobial stewardship interventions could delay or prevent the development of higher levels of antimicrobial resistance in the future. In food-producing animals in Australia, high-importance antimicrobials, as rated by the Australian Strategic and Technical Advisory Group (ASTAG), include virginiamycin and third-generation cephalosporins (in individual pigs or cattle). The use of high-importance antimicrobials in companion animals is more widespread and less regulated. There is no national antimicrobial use surveillance system for animals in Australia. Consequently, there is a gap in the knowledge about reasonable use across all sectors of veterinary practice. This study explored attitudes towards the use in veterinary medicine of antimicrobials with high importance to human health, and determined levels of agreement about the introduction of restrictions or other conditions on this use. An online survey was distributed via social media and email from June to December 2020 to veterinarians working in Australia. Of the 278 respondents working in clinical practice, 49% had heard of the ASTAG rating system, and 22% used a traffic light system for antimicrobial importance in their practice. Overall, 61% of participants disagreed that veterinarians should be able to prescribe high-importance antimicrobials without restrictions. If there were to be restrictions, there was most agreement amongst all respondents for only restricting high-importance antimicrobials (73%). There is a need for education, guidance, and practical support for veterinarians for prescribing high-importance antimicrobials alongside any restrictions.
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4
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MacPherson EE, Reynolds J, Sanudi E, Nkaombe A, Phiri C, Mankhomwa J, Dixon J, Chandler CIR. Understanding antimicrobial resistance through the lens of antibiotic vulnerabilities in primary health care in rural Malawi. Glob Public Health 2022; 17:2630-2646. [PMID: 34932915 DOI: 10.1080/17441692.2021.2015615] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The diminishing effectiveness of antimicrobials raises serious concerns for human health. While policy makers grapple to reduce the overuse of antimicrobial medicines to stem the rise of antimicrobial resistance, insufficient attention has been paid to how this applies to low-resource contexts. We provide an in-depth portrayal of antimicrobial prescribing at primary health care level in rural Chikwawa District, Malawi. Ethnographic fieldwork took place over 18 months (2018-2020). We surveyed 22 health facilities in the district, observed 1348 health worker-patient consultations, and carried out 49 in-depth interviews with staff and patients. Care was centred around provision of an antimicrobial. Amid chronic lack of essential medicines and other resources, clinic interactions were tightly scripted, providing patients little time to question or negotiate their treatment. We develop the concept of 'antibiotic vulnerabilities' to reveal multiple ways in which provision of antimicrobials in rural Malawi impacts care in conditions of extreme scarcity. Antibiotics are central and essential to primary care. As targets for optimal antimicrobial prescribing take a more central role in global policy, close attention is required of the ramifications for the delivery of care to ensure that efforts to stem resistance do not undermine the goal of improved health for all.
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Affiliation(s)
- Eleanor E MacPherson
- Malawi-Liverpool-Wellcome Trust and Liverpool School of Tropical Medicine, Blantyre, Malawi
| | | | | | | | | | | | - Justin Dixon
- London School of Hygiene and Tropical Medicine, London, UK
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5
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Jamrozik E, Heriot GS. Ethics and antibiotic resistance. Br Med Bull 2022; 141:4-14. [PMID: 35136968 PMCID: PMC8935610 DOI: 10.1093/bmb/ldab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/28/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION OR BACKGROUND Antibiotic resistance raises ethical issues due to the severe and inequitably distributed consequences caused by individual actions and policies. SOURCES OF DATA Synthesis of ethical, scientific and clinical literature. AREAS OF AGREEMENT Ethical analyses have focused on the moral responsibilities of patients to complete antibiotic courses, resistance as a tragedy of the commons and attempts to limit use through antibiotic stewardship. AREAS OF CONTROVERSY Each of these analyses has significant limitations and can result in self-defeating or overly narrow implications for policy. GROWING POINTS More complex analyses focus on ethical implications of ubiquitous asymptomatic carriage of resistant bacteria, non-linear outcomes within and between patients over time and global variation in resistant disease burdens. AREAS TIMELY FOR DEVELOPING RESEARCH Neglected topics include the harms of antibiotic use, including off-target effects on the human microbiome, and the lack of evidence guiding most antibiotic prescription decisions.
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Affiliation(s)
- Euzebiusz Jamrozik
- The Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford. Old Road Campus, Oxford OX3 7LF, UK.,Monash Bioethics Centre, Monash University, Wellington Rd, Clayton, 3800, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 300 Grattan St, Parkville, 3050, Victoria, Australia
| | - George S Heriot
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 300 Grattan St, Parkville, 3050, Victoria, Australia
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6
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Böhm R, Holtmann-Klenner C, Korn L, Santana AP, Betsch C. Behavioral determinants of antibiotic resistance: The role of social information. Appl Psychol Health Well Being 2022; 14:757-775. [PMID: 35103398 PMCID: PMC9544926 DOI: 10.1111/aphw.12345] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/19/2022] [Indexed: 12/01/2022]
Abstract
The increasing development of resistant pathogens is one of the greatest global health challenges. As antibiotic overuse amplifies antibiotic resistance, antibiotic intake poses a social dilemma in which individuals need to decide whether to prosocially reduce their intake in the collective interest versus to (over)use it even in case of mild diseases. We devise a novel behavioral game paradigm to model the social dilemma of antibiotic intake. Using this new method in an incentivized laboratory experiment (N = 272 German participants), we varied whether players had mutual knowledge about their antibiotic intake. The results indicate that there was substantial antibiotic overuse in the absence of social information. Overuse decreased when social information was present. Our postexperimental survey data further suggest that social information impacts people's behavioral motivation, evaluation of the other player, and positive affect. Taken together, providing social information about people's antibiotic intake may help in reducing antibiotic overuse. On a more general level, the novel behavioral game may be adapted to study other aspects of antibiotic intake to promote prudent use of antibiotics.
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Affiliation(s)
- Robert Böhm
- Faculty of Psychology, University of Vienna, Vienna, Austria.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen, Denmark
| | - Cindy Holtmann-Klenner
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany
| | - Lars Korn
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany.,Media and Communication Science, University of Erfurt, Erfurt, Germany.,Health Communication, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Ana Paula Santana
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany.,Media and Communication Science, University of Erfurt, Erfurt, Germany.,Health Communication, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
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7
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Iskandar K, Murugaiyan J, Hammoudi Halat D, Hage SE, Chibabhai V, Adukkadukkam S, Roques C, Molinier L, Salameh P, Van Dongen M. Antibiotic Discovery and Resistance: The Chase and the Race. Antibiotics (Basel) 2022; 11:antibiotics11020182. [PMID: 35203785 PMCID: PMC8868473 DOI: 10.3390/antibiotics11020182] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022] Open
Abstract
The history of antimicrobial resistance (AMR) evolution and the diversity of the environmental resistome indicate that AMR is an ancient natural phenomenon. Acquired resistance is a public health concern influenced by the anthropogenic use of antibiotics, leading to the selection of resistant genes. Data show that AMR is spreading globally at different rates, outpacing all efforts to mitigate this crisis. The search for new antibiotic classes is one of the key strategies in the fight against AMR. Since the 1980s, newly marketed antibiotics were either modifications or improvements of known molecules. The World Health Organization (WHO) describes the current pipeline as bleak, and warns about the scarcity of new leads. A quantitative and qualitative analysis of the pre-clinical and clinical pipeline indicates that few antibiotics may reach the market in a few years, predominantly not those that fit the innovative requirements to tackle the challenging spread of AMR. Diversity and innovation are the mainstays to cope with the rapid evolution of AMR. The discovery and development of antibiotics must address resistance to old and novel antibiotics. Here, we review the history and challenges of antibiotics discovery and describe different innovative new leads mechanisms expected to replenish the pipeline, while maintaining a promising possibility to shift the chase and the race between the spread of AMR, preserving antibiotic effectiveness, and meeting innovative leads requirements.
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Affiliation(s)
- Katia Iskandar
- Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR 1295, 31000 Toulouse, France
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573, Lebanon;
- Faculty of Pharmacy, Lebanese University, Beirut 6573, Lebanon
- Correspondence: (K.I.); (D.H.H.)
| | - Jayaseelan Murugaiyan
- Department of Biological Sciences, SRM University–AP, Amaravati 522502, India; (J.M.); (S.A.)
| | - Dalal Hammoudi Halat
- Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese International University, Bekaa Campus, Beirut 1103, Lebanon
- Correspondence: (K.I.); (D.H.H.)
| | - Said El Hage
- Faculty of Medicine, Lebanese University, Beirut 6573, Lebanon;
| | - Vindana Chibabhai
- Division of Clinical Microbiology and Infectious Diseases, School of Pathology, University of the Witwatersrand, Johannesburg 2193, South Africa;
- Microbiology Laboratory, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
| | - Saranya Adukkadukkam
- Department of Biological Sciences, SRM University–AP, Amaravati 522502, India; (J.M.); (S.A.)
| | - Christine Roques
- Laboratoire de Génie Chimique, Department of Bioprocédés et Systèmes Microbiens, Université Paul Sabtier, Toulouse III, UMR 5503, 31330 Toulouse, France;
| | - Laurent Molinier
- Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR 1295, Université Paul Sabatier Toulouse III, 31000 Toulouse, France;
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573, Lebanon;
- Faculty of Medicine, Lebanese University, Beirut 6573, Lebanon;
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia 2408, Cyprus
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8
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Wong LH, Tay E, Heng ST, Guo H, Kwa ALH, Ng TM, Chung SJ, Somani J, Lye DCB, Chow A. Hospital Pharmacists and Antimicrobial Stewardship: A Qualitative Analysis. Antibiotics (Basel) 2021; 10:antibiotics10121441. [PMID: 34943655 PMCID: PMC8698014 DOI: 10.3390/antibiotics10121441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Antimicrobial stewardship programmes (ASPs) in hospitals are predominantly led by specific ASP physicians and pharmacists. Limited studies have been conducted to appreciate non-ASP-trained hospital pharmacists' perspectives on their roles in antimicrobial stewardship. Focus group discussions (FGDs) were conducted with 74 pharmacists, purposively sampled from the 3 largest acute-care public hospitals in Singapore, to explore facilitators and barriers faced by them in antimicrobial stewardship. Applied thematic analysis was conducted and codes were categorised using the social-ecological model (SEM). At the intrapersonal level, pharmacists identified themselves as reviewers for drug safety before dispensing, confining to a restricted advisory role due to lack of clinical knowledge, experience, and empowerment to contribute actively to physicians' prescribing decisions. At the interpersonal level, pharmacists expressed difficulties conveying their opinions and recommendations on antibiotic therapy to physicians despite frequent communications, but they assumed critical roles as educators for patients and their caregivers on proper antibiotic use. At the organisational level, in-house antibiotic guidelines supported pharmacists' antibiotic interventions and recommendations. At the community level, pharmacists were motivated to improve low public awareness and knowledge on antibiotic use and antimicrobial resistance. These findings provide important insights into the gaps to be addressed in order to harness the untapped potential of hospital pharmacists and fully engage them in antimicrobial stewardship.
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Affiliation(s)
- Lok Hang Wong
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore 308433, Singapore; (L.H.W.); (E.T.); (H.G.)
| | - Evonne Tay
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore 308433, Singapore; (L.H.W.); (E.T.); (H.G.)
- Infectious Disease Research and Training Office, National Centre for Infectious Diseases, Singapore 308443, Singapore;
| | - Shi Thong Heng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore 308433, Singapore; (S.T.H.); (T.M.N.)
| | - Huiling Guo
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore 308433, Singapore; (L.H.W.); (E.T.); (H.G.)
| | - Andrea Lay Hoon Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore;
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Tat Ming Ng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore 308433, Singapore; (S.T.H.); (T.M.N.)
| | - Shimin Jasmine Chung
- Department of Infectious Diseases, Singapore General Hospital, Singapore 169608, Singapore;
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Jyoti Somani
- Division of Infectious Diseases, National University Hospital, Singapore 119074, Singapore;
| | - David Chien Boon Lye
- Infectious Disease Research and Training Office, National Centre for Infectious Diseases, Singapore 308443, Singapore;
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
| | - Angela Chow
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore 308433, Singapore; (L.H.W.); (E.T.); (H.G.)
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
- Correspondence: ; Tel.: +65-6357-7477; Fax: +65-6357-7957
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9
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Guo H, Hildon ZJL, Loh VWK, Sundram M, Ibrahim MAB, Tang WE, Chow A. Exploring antibiotic prescribing in public and private primary care settings in Singapore: a qualitative analysis informing theory and evidence-based planning for value-driven intervention design. BMC FAMILY PRACTICE 2021; 22:205. [PMID: 34654368 PMCID: PMC8519324 DOI: 10.1186/s12875-021-01556-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Singapore's healthcare system presents an ideal context to learn from diverse public and private operational models and funding systems. AIM To explore processes underpinning decision-making for antibiotic prescribing, by considering doctors' experiences in different primary care settings. METHODS Thirty semi-structured interviews were conducted with 17 doctors working in publicly funded primary care clinics (polyclinics) and 13 general practitioners (GP) working in private practices (solo, small and large). Data were analysed using applied thematic analysis following realist principles, synthesised into a theoretical model, informing solutions to appropriate antibiotic prescribing. RESULTS Given Singapore's lack of national guidelines for antibiotic prescribing in primary care, practices are currently non-standardised. Themes contributing to optimal prescribing related first and foremost to personal valuing of reduction in antimicrobial resistance (AMR) which was enabled further by organisational culture creating and sustaining such values, and if patients were convinced of these too. Building trusting patient-doctor relationships, supported by reasonable patient loads among other factors were consistently observed to allow shared decision-making enabling optimal prescribing. Transparency and applying data to inform practice was a minority theme, nevertheless underpinning all levels of optimal care delivery. These themes are synthesised into the VALUE model proposed for guiding interventions to improve antibiotic prescribing practices. These should aim to reinforce intrapersonal Values consistent with prioritising AMR reduction, and Aligning organisational culture to these by leveraging standardised guidelines and interpersonal intervention tools. Such interventions should account for the wider systemic constraints experienced in publicly funded high patient turnover institutions, or private clinics with transactional models of care. Thus, ultimately a focus on Liaison between patient and doctor is crucial. For instance, building in adequate consultation time and props as discussion aids, or quick turnover communication tools in time-constrained settings. Message consistency will ultimately improve trust, helping to enable shared decision-making. Lastly, Use of monitoring data to track and Evaluate antibiotic prescribing using meaningful indicators, that account for the role of shared decision-making can also be leveraged for change. CONCLUSIONS These VALUE dimensions are recommended as potentially transferable to diverse contexts, and the model as implementation tool to be tested empirically and updated accordingly.
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Affiliation(s)
- Huiling Guo
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems, Singapore, Singapore
| | - Zoe Jane-Lara Hildon
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems, Singapore, Singapore.
| | - Victor Weng Keong Loh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Meena Sundram
- National University Polyclinics, Singapore, Singapore
| | - Muhamad Alif Bin Ibrahim
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore, Singapore
- School of Social and Health Sciences, James Cook University, Singapore Campus, Singapore, Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Angela Chow
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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10
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Krockow EM, Tarrant C, Colman AM. Prosociality in the social dilemma of antibiotic prescribing. Curr Opin Psychol 2021; 44:164-169. [PMID: 34662776 DOI: 10.1016/j.copsyc.2021.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 01/21/2023]
Abstract
Antibiotic prescribing can be conceptualised as a social dilemma in which the overuse of antibiotics, to minimise immediate risks to individual patients, results in a sub-optimal outcome for society (antimicrobial resistance) and increased risks to all patients in the long run. Doctors face the challenge of balancing the interests of individual patients against the collective good when prescribing antibiotics. While evidence suggests that doctors tend to prioritise individual interests over those of the collective, the conventional interpretation of such decisions as selfish may be inappropriate because most doctors are motivated by prosocial concerns about their patients. This review of antibiotic decision research provides a more nuanced understanding of prosociality in the context of the social dilemma of antibiotic prescribing.
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Affiliation(s)
- Eva M Krockow
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, University Road, Leicester, LE1 7RK, United Kingdom.
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, University Road, Leicester, LE1 7RK, United Kingdom
| | - Andrew M Colman
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, University Road, Leicester, LE1 7RK, United Kingdom
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11
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Charani E, McKee M, Ahmad R, Balasegaram M, Bonaconsa C, Merrett GB, Busse R, Carter V, Castro-Sanchez E, Franklin BD, Georgiou P, Hill-Cawthorne K, Hope W, Imanaka Y, Kambugu A, Leather AJM, Mbamalu O, McLeod M, Mendelson M, Mpundu M, Rawson TM, Ricciardi W, Rodriguez-Manzano J, Singh S, Tsioutis C, Uchea C, Zhu N, Holmes AH. Optimising antimicrobial use in humans - review of current evidence and an interdisciplinary consensus on key priorities for research. THE LANCET REGIONAL HEALTH. EUROPE 2021; 7:100161. [PMID: 34557847 PMCID: PMC8454847 DOI: 10.1016/j.lanepe.2021.100161] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Addressing the silent pandemic of antimicrobial resistance (AMR) is a focus of the 2021 G7 meeting. A major driver of AMR and poor clinical outcomes is suboptimal antimicrobial use. Current research in AMR is inequitably focused on new drug development. To achieve antimicrobial security we need to balance AMR research efforts between development of new agents and strategies to preserve the efficacy and maximise effectiveness of existing agents. Combining a review of current evidence and multistage engagement with diverse international stakeholders (including those in healthcare, public health, research, patient advocacy and policy) we identified research priorities for optimising antimicrobial use in humans across four broad themes: policy and strategic planning; medicines management and prescribing systems; technology to optimise prescribing; and context, culture and behaviours. Sustainable progress depends on: developing economic and contextually appropriate interventions; facilitating better use of data and prescribing systems across healthcare settings; supporting appropriate and scalable technological innovation. Implementing this strategy for AMR research on the optimisation of antimicrobial use in humans could contribute to equitable global health security.
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Affiliation(s)
- Esmita Charani
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, South Africa
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Raheelah Ahmad
- School of Health Sciences City, University of London, UK
| | - Manica Balasegaram
- The Global Antibiotic Research and Development Partnership, Geneva, Switzerland
| | - Candice Bonaconsa
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, South Africa
| | | | | | - Vanessa Carter
- Stanford University Medicine X e-Patient Scholars Program 2017, Health Communication and Social Media South Africa, Africa CDC Civil Society Champion for AMR
| | - Enrique Castro-Sanchez
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
| | - Bryony D Franklin
- University College London School of Pharmacy, London, UK
- Imperial College Healthcare NHS Trust, Centre for Medication Safety and Service Quality, Pharmacy Department, London, UK
| | - Pantelis Georgiou
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, UK
| | - Kerri Hill-Cawthorne
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
| | - William Hope
- Department of Molecular and Clinical Pharmacology, University of Liverpool, UK
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Andrew Kambugu
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew JM Leather
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Oluchi Mbamalu
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, South Africa
| | - M McLeod
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
- Imperial College Healthcare NHS Trust, Centre for Medication Safety and Service Quality, Pharmacy Department, London, UK
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, South Africa
| | | | - Timothy M Rawson
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
- Department of Bioengineering, Imperial College London, London, UK
| | | | - Jesus Rodriguez-Manzano
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, UK
- Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London
| | - Sanjeev Singh
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi (Kerala), India
| | - Constantinos Tsioutis
- Department of Internal Medicine and Infection Prevention and Control, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Chibuzor Uchea
- Drug-Resistant Infections Priority Programme,Wellcome Trust, London, UK
| | - Nina Zhu
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
| | - Alison H Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
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12
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Taber P, Weir C, Butler JM, Graber CJ, Jones MM, Madaras-Kelly K, Zhang Y, Chou AF, Samore MH, Goetz MB, Glassman PA. Social dynamics of a population-level dashboard for antimicrobial stewardship: A qualitative analysis. Am J Infect Control 2021; 49:862-867. [PMID: 33515622 DOI: 10.1016/j.ajic.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate antimicrobial stewards' experiences of using a dashboard display integrating local and national antibiotic use data implemented in the U.S. Department of Veterans Affairs (VA). This paper reports early formative evaluation. DESIGN Qualitative interviewing. SETTING Eight VA hospitals participated with established antimicrobial stewardship (AS) programs participated in the pilot. PARTICIPANTS Six infectious disease physicians and eight clinical pharmacists agreed to be interviewed (n = 14). METHODS A 3-part qualitative interview script was used involving a description of local stewardship activities, a Critical Incident description of dashboard use, and general questions regarding attitudes towards the tool. An inductive open coding approach was used for analysis. RESULTS We found 4 themes showing the complexities of using stewardship tools: (1) Data validity is socially negotiated; (2) Performance feedback motivates and persuades social goals when situated in an empirical distribution; (3) Shared problem awareness is aided by authoritative data; and (4) The AS dashboard encourages connections with local quality improvement culture. CONCLUSIONS Social dimensions of AS tool use emerged as distinct from, and equally important as decision support provided by the dashboard. Successful stewardship tools should be designed to support both the social and cognitive needs of users.
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Affiliation(s)
- Peter Taber
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT.
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT; IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, UT.
| | - Jorie M Butler
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT; IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, UT; Geriatric Education and Clinical Center, VA Salt Lake City Healthcare System, Salt Lake City, UT; Department of Medicine, University of Utah, Salt Lake City, UT
| | - Christopher J Graber
- Center for Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Medicine, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA; Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Makoto M Jones
- IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, UT; Geriatric Education and Clinical Center, VA Salt Lake City Healthcare System, Salt Lake City, UT; Division of Epidemiology, University of Utah, Salt Lake City, UT
| | - Karl Madaras-Kelly
- Department of Pharmacy Boise VA Medical Center, Boise, ID; College of Pharmacy, Idaho State University, Meridian, ID
| | - Yue Zhang
- IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, UT; Geriatric Education and Clinical Center, VA Salt Lake City Healthcare System, Salt Lake City, UT; Division of Epidemiology, University of Utah, Salt Lake City, UT
| | - Ann F Chou
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Matthew H Samore
- IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, UT; Geriatric Education and Clinical Center, VA Salt Lake City Healthcare System, Salt Lake City, UT; Division of Epidemiology, University of Utah, Salt Lake City, UT
| | - Matthew Bidwell Goetz
- Center for Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Medicine, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA; Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Peter A Glassman
- Center for Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA; VA Pharmacy Benefits Management Services, Department of Veterans Affairs, Washington, DC; Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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13
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Felsen CB, Dodds Ashley ES, Barney GR, Nelson DL, Nicholas JA, Yang H, Aydelotte ME, Karlic A, Nicholas NC, Petrone KK, Pine RD, Schabel SL, Medina-Walpole A, Dumyati GK. Reducing Fluoroquinolone Use and Clostridioides difficile Infections in Community Nursing Homes Through Hospital-Nursing Home Collaboration. J Am Med Dir Assoc 2021; 21:55-61.e2. [PMID: 31888865 DOI: 10.1016/j.jamda.2019.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Nursing homes (NHs) are an important target for antibiotic stewardship (AS). We describe a collaborative model to reduce Clostridioides difficile infections (CDIs) in NHs through optimization of antibiotic use including a reduction in high-risk antibiotics such as fluoroquinolones. DESIGN Quasi-experimental, pre- and post-intervention study. SETTING AND PARTICIPANTS Six NHs in Monroe County, NY. METHODS A hospital-based AS expert team assisted NHs in identifying targets for improving antibiotic use. Interventions included (1) collaboration with a medical director advisory group to develop NH consensus guidelines for testing and treatment of 2 syndromes (urinary tract infections and pneumonia) for which fluoroquinolone use is common, (2) provision of multifaceted NH staff education on these guidelines and education of residents and family members on the judicious use of antibiotics, and (3) sharing facility-specific and comparative antibiotic and CDI data. We used Poisson regression to estimate antibiotic use per 1000 resident days (RD) and CDIs per 10,000 RD, pre- and post-intervention. Segmented regression analysis was used to estimate changes in fluoroquinolone and total antibiotic rates over time. RESULTS Postintervention, the monthly rate of fluoroquinolone days of therapy (DOT) per 1000 RD significantly decreased by 39% [rate ratio (RR) 0.61, 95% confidence interval (CI) 0.59-0.62, P < .001] across all NHs and the total antibiotic DOT decreased by 9% (RR 0.91, 95% CI 0.90-0.92, P < .001). Interrupted time series analysis of fluoroquinolone and total DOT rates confirmed these changes. The quarterly CDI rate decreased by 18% (RR 0.82, 95% CI 0.68-0.99, P = .042). CONCLUSIONS AND IMPLICATIONS A hospital-NH partnership with a medical director advisory group achieved a significant reduction in total antibiotic and fluoroquinolone use and contributed to a reduction in CDI incidence. This approach offers one way for NHs to gain access to AS expertise and resources and to standardize practices within the local community.
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Affiliation(s)
- Christina B Felsen
- Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, NY
| | - Elizabeth S Dodds Ashley
- Division of Infectious Diseases and International Health, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC
| | - Grant R Barney
- Emerging Infections Program, New York State Department of Health, Albany, NY
| | - Dallas L Nelson
- Department of Medicine, Geriatrics/Aging University of Rochester Medical Center, Rochester, NY
| | - Joseph A Nicholas
- Department of Medicine and Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Hongmei Yang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | | | - Alexander Karlic
- Unity Living Center and Unity Hospital, Rochester Regional Health, Rochester, NY
| | - Nirmala C Nicholas
- Department of Medicine, Geriatrics/Aging University of Rochester Medical Center, Rochester, NY
| | | | | | - Scott L Schabel
- Division of Long Term Care, Rochester Regional Health, Rochester, NY
| | - Annette Medina-Walpole
- Department of Medicine, Geriatrics/Aging University of Rochester Medical Center, Rochester, NY
| | - Ghinwa K Dumyati
- Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, NY; Department of Medicine, Division of Infectious Disease, University of Rochester Medical Center, Rochester, NY.
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14
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Krockow EM, Kurvers RHJM, Herzog SM, Kämmer JE, Hamilton RA, Thilly N, Macheda G, Pulcini C. Harnessing the wisdom of crowds can improve guideline compliance of antibiotic prescribers and support antimicrobial stewardship. Sci Rep 2020; 10:18782. [PMID: 33139823 PMCID: PMC7608639 DOI: 10.1038/s41598-020-75063-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/09/2020] [Indexed: 12/26/2022] Open
Abstract
Antibiotic overprescribing is a global challenge contributing to rising levels of antibiotic resistance and mortality. We test a novel approach to antibiotic stewardship. Capitalising on the concept of "wisdom of crowds", which states that a group's collective judgement often outperforms the average individual, we test whether pooling treatment durations recommended by different prescribers can improve antibiotic prescribing. Using international survey data from 787 expert antibiotic prescribers, we run computer simulations to test the performance of the wisdom of crowds by comparing three data aggregation rules across different clinical cases and group sizes. We also identify patterns of prescribing bias in recommendations about antibiotic treatment durations to quantify current levels of overprescribing. Our results suggest that pooling the treatment recommendations (using the median) could improve guideline compliance in groups of three or more prescribers. Implications for antibiotic stewardship and the general improvement of medical decision making are discussed. Clinical applicability is likely to be greatest in the context of hospital ward rounds and larger, multidisciplinary team meetings, where complex patient cases are discussed and existing guidelines provide limited guidance.
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Affiliation(s)
- Eva M Krockow
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, LE1 7RH, UK.
| | - R H J M Kurvers
- Center for Adaptive Rationality, Max-Planck Institute for Human Development, Berlin, Germany
| | - S M Herzog
- Center for Adaptive Rationality, Max-Planck Institute for Human Development, Berlin, Germany
| | - J E Kämmer
- Center for Adaptive Rationality, Max-Planck Institute for Human Development, Berlin, Germany
- Department of Emergency Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - R A Hamilton
- School of Pharmacy, De Montfort University, Leicester, UK
| | - N Thilly
- Université de Lorraine, APEMAC, Nancy, France
| | - G Macheda
- Université de Lorraine, APEMAC, Nancy, France
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France
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15
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Broom A, Kenny K, Prainsack B, Broom J. Antimicrobial resistance as a problem of values? Views from three continents. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1725444] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Alex Broom
- Department of Sociology and Social Policy, School of Social and Political Sciences, The University of Sydney, Sydney, Australia
| | - Katherine Kenny
- Department of Sociology and Social Policy, School of Social and Political Sciences, The University of Sydney, Sydney, Australia
| | - Barbara Prainsack
- Department of Political Science, University of Vienna, Vienna, Austria
| | - Jennifer Broom
- Sunshine Coast, Sunshine Coast University Hospital, Queensland, Australia
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16
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Tarrant C, Krockow EM, Nakkawita WMID, Bolscher M, Colman AM, Chattoe-Brown E, Perera N, Mehtar S, Jenkins DR. Moral and Contextual Dimensions of "Inappropriate" Antibiotic Prescribing in Secondary Care: A Three-Country Interview Study. FRONTIERS IN SOCIOLOGY 2020; 5:7. [PMID: 33869416 PMCID: PMC8022648 DOI: 10.3389/fsoc.2020.00007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/04/2020] [Indexed: 05/08/2023]
Abstract
Overuse of broad-spectrum antibiotics in secondary care is a key contributor to the emergence and spread of antimicrobial resistance (AMR); efforts are focused on minimizing antibiotic overuse as a crucial step toward containing the global threat of AMR. The concept of overtreatment has, however, been difficult to define. Efforts to address the overuse of medicine need to be informed by an understanding of how prescribers themselves understand the problem. We report findings from a qualitative interview study of 46 acute care hospital prescribers differing in seniority from three countries: United Kingdom, Sri Lanka and South Africa. Prescribers were asked about their understanding of inappropriate use of antibiotics. Prescriber definitions of inappropriate use included relatively clear-cut and unambiguous cases of antibiotics being used "incorrectly" (e.g., in the case of viral infections). In many cases, however, antibiotic prescribing decisions were seen as involving uncertainty, with prescribers having to make decisions about the threshold for appropriate use. Decisions about thresholds were commonly framed in moral terms. Some prescribers drew on arguments about their duty to protect public health through having a high threshold for prescribing, while others made strong arguments for prioritizing risk avoidance for the patients in front of them, even at a cost of increased resistance. Notions of whether prescribing was inappropriate were also contextually dependent: high levels of antibiotic prescribing could be seen as a rational response when prescribers were working in challenging contexts, and could be justified in relation to financial and social considerations. Inappropriate antibiotic use is framed by prescribers not just in clinical, but also in moral and contextual terms; this has implications for the design and implementation of antibiotic stewardship interventions aiming to reduce inappropriate use of antibiotics globally.
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Affiliation(s)
- Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- *Correspondence: Carolyn Tarrant
| | - Eva M. Krockow
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | | | - Michele Bolscher
- Tygerberg Academic Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andrew M. Colman
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Edmund Chattoe-Brown
- School of Media, Communication and Sociology, University of Leicester, Leicester, United Kingdom
| | - Nelun Perera
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Shaheen Mehtar
- Tygerberg Academic Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David R. Jenkins
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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17
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Carlsson F, Jacobsson G, Jagers SC, Lampi E, Robertson F, Rönnerstrand B. Who is willing to stay sick for the collective? - Individual characteristics, experience, and trust. SSM Popul Health 2019; 9:100499. [PMID: 31993488 PMCID: PMC6978473 DOI: 10.1016/j.ssmph.2019.100499] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/18/2019] [Accepted: 10/09/2019] [Indexed: 01/02/2023] Open
Abstract
We study attitudes towards antibiotics and antibiotic resistance. We analyze results from a novel web-survey of Swedish citizens (n = 1906). Acceptability of doctor's decision not to prescribe antibiotics was found to be large. Trust in the healthcare sector is linked to acceptability of doctor's decision. Concern about antibiotic resistance is linked to willingness to limit antibiotic use.
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Affiliation(s)
- Fredrik Carlsson
- Department of Economics, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Centre for Collective Action Research (CeCAR), University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Jacobsson
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sverker C Jagers
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Centre for Collective Action Research (CeCAR), University of Gothenburg, Gothenburg, Sweden.,Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Elina Lampi
- Department of Economics, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Centre for Collective Action Research (CeCAR), University of Gothenburg, Gothenburg, Sweden
| | - Felicia Robertson
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Centre for Collective Action Research (CeCAR), University of Gothenburg, Gothenburg, Sweden.,Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Björn Rönnerstrand
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Centre for Collective Action Research (CeCAR), University of Gothenburg, Gothenburg, Sweden.,The SOM Institute, University of Gothenburg, Gothenburg, Sweden
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18
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Hu Q, Yu Y, Gu D, Xie L, Chen X, Xu N, Ruan JJ, Dowson C, Ruan BH. Detection of "Hidden" Antimicrobial Drug Resistance. ACS Infect Dis 2019; 5:1252-1263. [PMID: 31243989 DOI: 10.1021/acsinfecdis.9b00132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Antimicrobial drug resistance has become a serious public health problem. The current clinical diagnostic methods are turbidity-based assays that have been used for years to track bacterial growth; however, the method is relatively insensitive. To eliminate the new occurrence of drug resistance in infectious bacteria, we developed a highly sensitive EZMTT method for the antibiotic susceptibility test (AST) that magnified the cell growth signal and revealed partial drug resistance (showing 2-20% weak cell growth) that was not detected by the current turbidity assay within 24 h. By simply mixing the EZMTT dye with the bacterial culture and then following the growth by absorbance measurement at 450 nm, the drug-induced proliferation (DIP) rate can be obtained in a high-throughput-screening (HTS) mode with greater than 10-fold better sensitivity than the turbidity assay. The EZMTT-based DIP rate assay of 5 clinically isolated E. coli strains found approximately 30% more partial drug resistance than what was detected in the traditional turbidity-based assay. The observed partial drug resistance was further confirmed by mechanistic analyses. Therefore, a combination of the EZMTT dye and the current clinically used VITEK-type technology has great potential to help understand antimicrobial drug resistance and ultimately provide patients with precise medical care to prevent the occurrence of multidrug resistant bacteria.
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Affiliation(s)
- Qingfeng Hu
- Clinical Diagnostic Lab, Renming Hospital of Zhejiang Province, Hangzhou, Zhejiang 310014, China
| | - Yan Yu
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, IDD & CB, Zhejiang University of Technology, 18 Chaowang Road, Xiachengqu, Hangzhou, Zhejiang 310014, China
| | - Dongshi Gu
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, IDD & CB, Zhejiang University of Technology, 18 Chaowang Road, Xiachengqu, Hangzhou, Zhejiang 310014, China
| | - Li Xie
- Center for M. tuberculosis Research, Hangzhou, Zhejiang 310019, China
| | - Xingrou Chen
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, IDD & CB, Zhejiang University of Technology, 18 Chaowang Road, Xiachengqu, Hangzhou, Zhejiang 310014, China
| | - Ning Xu
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, IDD & CB, Zhejiang University of Technology, 18 Chaowang Road, Xiachengqu, Hangzhou, Zhejiang 310014, China
| | - Jennifer Jin Ruan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York 10009, United States
| | - Christopher Dowson
- School of Life Sciences, University of Warwick, Coventry CV47AJ, United Kingdom
| | - Benfang Helen Ruan
- College of Pharmaceutical Science, Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, IDD & CB, Zhejiang University of Technology, 18 Chaowang Road, Xiachengqu, Hangzhou, Zhejiang 310014, China
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19
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Adam K. Balancing conflicting demands: factors influencing vets’ choice of antimicrobial agent. Vet Rec 2019; 184:795-797. [DOI: 10.1136/vr.l4060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Katherine Adam
- Innogen Institute, Science, Technology and Innovation Studies, School of Social and Political Science, University of Edinburgh; Edinburgh UK
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