1
|
Moya S, Coviglio A, Belloc C, Comer C, Eberhart J, Fortané N, Paul MC. A qualitative analysis of the unwritten rules influencing antibiotic prescribing practices among French poultry veterinarians. JAC Antimicrob Resist 2024; 6:dlae044. [PMID: 38486661 PMCID: PMC10939441 DOI: 10.1093/jacamr/dlae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/10/2024] [Indexed: 03/17/2024] Open
Abstract
Background It is now recognized that a better understanding of prescriber behaviour is needed to improve antimicrobial stewardship programmes. Most studies conducted in the livestock sector have focused on farmers' perspectives, while the prescribing habits of veterinarians have remained overlooked. Objective Our study explored the psychosocial determinants associated with antibiotic prescribing practices in the French poultry sector by analysing the informal norms and unwritten rules that influence veterinarians' prescribing decisions. Methods A qualitative study was conducted in four French regions in February 2021. Using the biographical narrative interpretive method, semi-structured interviews were conducted with 16 poultry veterinarians with varying professional experience. Three main themes were retained for data analysis: (i) compliance with and deviations from prescribing recommendations, (ii) the influence of fellow veterinarians on antibiotic decisions and (iii) the key role of veterinary corporate groups. Results When prescribing antibiotics, junior veterinarians were strongly influenced by senior veterinarians who acted as role models driving clinical practices. Prescribing habits were shared through peer networks in which veterinarians participated throughout their careers. Finally, veterinary corporate groups helped to shape veterinarians' prescribing habits by promoting existing guidelines and even producing in-house recommendations. Conclusions We show that, in parallel with official guidelines, prescribing habits circulate among veterinarians and are shared in professional circles. Therefore, antimicrobial stewardship interventions should focus not only on official guidelines and communication channels, but also unwritten professional rules and organizations influencing veterinarians' prescribing practices.
Collapse
Affiliation(s)
- Sebastián Moya
- Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Paris, France
- Interactions Hôtes-Agents Pathogènes (IHAP), École Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse, Toulouse, France
| | - Alexandra Coviglio
- Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Paris, France
- Interactions Hôtes-Agents Pathogènes (IHAP), École Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse, Toulouse, France
| | - Catherine Belloc
- Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Paris, France
- École Nationale Vétérinaire Agroalimentaire et de l’Alimentation (ONIRIS), Nantes, France
| | - Clementine Comer
- Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Paris, France
- Université Paris-Dauphine (UPD)—Paris Sciences et Lettres (PSL), Paris, France
| | - Josephine Eberhart
- Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Paris, France
- Université Paris-Dauphine (UPD)—Paris Sciences et Lettres (PSL), Paris, France
| | - Nicolas Fortané
- Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Paris, France
- Université Paris-Dauphine (UPD)—Paris Sciences et Lettres (PSL), Paris, France
| | - Mathilde C Paul
- Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Paris, France
- Interactions Hôtes-Agents Pathogènes (IHAP), École Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse, Toulouse, France
| |
Collapse
|
2
|
Bailey P, Chen S, Al-Hasan MN, Olatosi B, Li X, Zhang J. Ecologic analysis of antimicrobial use in South Carolina hospitals during 2020-2022. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e232. [PMID: 38156220 PMCID: PMC10753502 DOI: 10.1017/ash.2023.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 12/30/2023]
Abstract
Background Factors influencing excessive antimicrobial utilization in hospitalized patients remain poorly understood, particularly with the COVID-19 pandemic. Methods In this retrospective cohort, we compared administrative data regarding antimicrobial prescriptions in hospitalized patients in South Carolina from March 2020 through September 2022. The study examined variables associated with antimicrobial use across demographics, COVID status, and length of stay, among other variables. Results Significant relationships were seen with antimicrobial use in COVID-19 positive patients (OR 2.00, 95% Confidence Interval (CI): 1.9-2.1), young adults (OR 1.08, 95% CI: 0.99-1.12, COVID-19 positive Blacks and Hispanics (OR 1.06, 95% CI: 1.01-1.11, OR 1.05, 95% CI: 0.89-1.23), and COVID-19 positive patients with ≥2 comorbid conditions (OR 1.55, 95% CI: 1.43-1.68). Discussion Further analysis in more than one healthcare system should explore these ecologic relationships further to understand if these are common trends to inform ongoing stewardship interventions.
Collapse
Affiliation(s)
- Pamela Bailey
- Department of Internal Medicine, Division of Infectious Diseases, Prisma Health—Midlands, Columbia, SC, USA
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Shujie Chen
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Majdi N. Al-Hasan
- Department of Internal Medicine, Division of Infectious Diseases, Prisma Health—Midlands, Columbia, SC, USA
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Bankole Olatosi
- Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina; Columbia, SC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
3
|
Kanan M, Ramadan M, Haif H, Abdullah B, Mubarak J, Ahmad W, Mari S, Hassan S, Eid R, Hasan M, Qahl M, Assiri A, Sultan M, Alrumaih F, Alenzi A. Empowering Low- and Middle-Income Countries to Combat AMR by Minimal Use of Antibiotics: A Way Forward. Antibiotics (Basel) 2023; 12:1504. [PMID: 37887205 PMCID: PMC10604829 DOI: 10.3390/antibiotics12101504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Antibiotic overuse poses a critical global health concern, especially in low- and middle-income countries (LMICs) where access to quality healthcare and effective regulatory frameworks often fall short. This issue necessitates a thorough examination of the factors contributing to antibiotic overuse in LMICs, including weak healthcare infrastructure, limited access to quality services, and deficiencies in diagnostic capabilities. To address these challenges, regulatory frameworks should be implemented to restrict non-prescription sales, and accessible point-of-care diagnostic tools must be emphasized. Furthermore, the establishment of effective stewardship programs, the expanded use of vaccines, and the promotion of health systems, hygiene, and sanitation are all crucial components in combating antibiotic overuse. A comprehensive approach that involves collaboration among healthcare professionals, policymakers, researchers, and educators is essential for success. Improving healthcare infrastructure, enhancing access to quality services, and strengthening diagnostic capabilities are paramount. Equally important are education and awareness initiatives to promote responsible antibiotic use, the implementation of regulatory measures, the wider utilization of vaccines, and international cooperation to tackle the challenges of antibiotic overuse in LMICs.
Collapse
Affiliation(s)
- Mohammed Kanan
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh 12211, Saudi Arabia
| | - Maali Ramadan
- Department of Pharmacy, Maternity and Children Hospital in Rafha, Rafha 76312, Saudi Arabia; (M.R.); (H.H.); (B.A.); (J.M.)
| | - Hanan Haif
- Department of Pharmacy, Maternity and Children Hospital in Rafha, Rafha 76312, Saudi Arabia; (M.R.); (H.H.); (B.A.); (J.M.)
| | - Bashayr Abdullah
- Department of Pharmacy, Maternity and Children Hospital in Rafha, Rafha 76312, Saudi Arabia; (M.R.); (H.H.); (B.A.); (J.M.)
| | - Jawaher Mubarak
- Department of Pharmacy, Maternity and Children Hospital in Rafha, Rafha 76312, Saudi Arabia; (M.R.); (H.H.); (B.A.); (J.M.)
| | - Waad Ahmad
- Department of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia; (W.A.); (S.M.)
| | - Shahad Mari
- Department of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia; (W.A.); (S.M.)
| | - Samaher Hassan
- Department of Clinical Pharmacy, Jazan College of Pharmacy, Jazan 82726, Saudi Arabia;
| | - Rawan Eid
- Department of Pharmacy, Nahdi Company, Tabuk 47311, Saudi Arabia;
| | - Mohammed Hasan
- Department of Pharmacy, Armed Forces Hospital Southern Region, Mushait 62562, Saudi Arabia; (M.H.); (A.A.)
| | - Mohammed Qahl
- Department of Pharmacy, Najran Armed Forces Hospital, Najran 66256, Saudi Arabia;
| | - Atheer Assiri
- Department of Pharmacy, Armed Forces Hospital Southern Region, Mushait 62562, Saudi Arabia; (M.H.); (A.A.)
| | | | - Faisal Alrumaih
- Department of Pharmacy, Northern Border University, Rafha 76313, Saudi Arabia;
| | - Areej Alenzi
- Department of Infection Control and Public Health, Regional Laboratory in Northern Border Region, Arar 73211, Saudi Arabia;
| |
Collapse
|
4
|
Sulis G, Sayood S, Gandra S. How can we tackle the overuse of antibiotics in low- and middle-income countries? Expert Rev Anti Infect Ther 2023; 21:1189-1201. [PMID: 37746828 DOI: 10.1080/14787210.2023.2263643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/22/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Antibiotic overuse is a pressing global health concern, particularly in low- and middle-income countries (LMICs) where there is limited access to quality healthcare and insufficient regulation of antibiotic dispensation. This perspective piece highlights the challenges of antibiotic overuse in LMICs and provides insights into potential solutions to address this issue. AREAS COVERED This perspective explores key factors contributing to antibiotic overuse in LMICs, encompassing weak healthcare infrastructure, limited access to quality services, and deficiencies in diagnostic capabilities. It discusses regulatory frameworks to curb non-prescription sales, the role of accessible point-of-care diagnostic tools, challenges in implementing effective stewardship programs, the expanded use of vaccines, and the importance of health systems, hygiene, and sanitation. EXPERT OPINION In this article, we emphasize the need for a comprehensive approach involving collaboration among healthcare professionals, policymakers, researchers, and educators. We underscore the importance of improving healthcare infrastructure, enhancing access to quality services, and strengthening diagnostic capabilities. The article also highlights the significance of education and awareness in promoting responsible antibiotic use, the role of regulatory measures, the expanded utilization of vaccines, and the need for international collaboration to address the challenges of antibiotic overuse in LMICs.
Collapse
Affiliation(s)
- Giorgia Sulis
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sena Sayood
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Sumanth Gandra
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|