Knowledge, attitudes and behaviors on antibiotic use and resistance among healthcare workers in Italy, 2019: investigation by a clustering method

Opinions of Medical Staff Regarding Antibiotic Resistance

INTRODUCTION

Antibiotic resistance poses a significant threat to public health, that can lead to reduced effectiveness of many therapies, increased morbidity, longer hospitalization times, increased deaths, and additional costs for health care systems. Unreasonable use of antibiotics may result from a lack of adequate knowledge about antibiotic therapy and a lack of knowledge of the risks associated with antibiotic resistance, both among medical personnel and patients.

AIM

The primary objective of the study was to verify the opinion of medical personnel on the risks associated with antibiotic resistance.

MATERIAL AND METHODS

The study was conducted in 2023 among 605 Polish sanitary workers. An anonymous survey designed specifically for the purpose of the study was used. The survey was made available on the Internet through the Trade Unions of Pharmacy Workers and directly to hospitals with the support of local authorities.

RESULTS

The majority of respondents were women (77.36%). The largest group consisted of individuals over 40 years of age (55.04%). More than half of the respondents were nurses (56.20%), and every fourth of the respondents was a physician (23.64%). Most respondents consider antibiotic resistance to be a very serious (24.13%) or extremely serious (30.75%) problem. The problem of antibiotic resistance on a global scale was mentioned, especially in the opinions of physicians and nurses (p < 0.01), people working in the profession for over a year (p < 0.01), and people with a specialization or undergoing specialist training (p = 0.00). Similarly, these groups most often indicated that antibiotic resistance poses a problem in their workplace. The main problems of antibiotic resistance were the use of antibiotics in farm animals (36.69%), the pressure on patients to take antibiotics (38.84%), and the prophylactic use of antibiotics (43.15%).

CONCLUSIONS

Medical personnel consider antibiotic resistance a somewhat serious problem, although not all agree in this regard. The risk of antibiotic resistance is much more seriously assessed by physicians and nurses, as well as by people with specializations or undergoing specialization training. Knowledge about antibiotic resistance should be further spread among all groups of medical personnel.

Knowledge, attitudes, and practices related to antibiotic resistance among physicians and nurses in Italian intensive care: A multicenter cross-sectional survey

OBJECTIVES

The aim of this study is to investigate the knowledge, attitudes and practices of Italian intensive-care physicians and nurses with respect to antibiotic resistance.

METHODS

A multicenter cross-sectional survey was conducted of 20 Italian intensive care units, supported by an online validated questionnaire.

RESULTS

A total of 143 participants took part, mainly nurses (79.7%). Most respondents were between 26 and 45 y old (62.9%), with more than 6 y of service (about 71%). Some 90% of those who took part stated that they were aware of the problem of antibiotic resistance and had easy access to guidelines and information materials on the subject. On the other hand, a high level of disagreement, mostly among nurses, emerged in relation to knowledge of the existence of national plans for the fight against AMR (62.9%) or the presence of international information campaigns (80%). A majority (76%) said they had received no specific training in the past 12 months. Most physicians (70%-90%) showed faith in their ability to prescribe, trusted guidelines, and recognized their role in antibiotic resistance by considering it while prescribing antimicrobial therapy.

CONCLUSIONS

The study highlights the need for targeted training interventions, especially for nurses, and the importance of involving all healthcare professionals in the fight against antibiotic resistance.

Association between quality of governance, antibiotic consumption, and antimicrobial resistance: an analysis of Italian regions

BACKGROUND

Emerging research has provided evidence suggesting the potential influence of governance on the development and spread of antimicrobial resistance (AMR), accounting for significant disparities observed both between and within countries. In our study, we conducted an ecological analysis to investigate the relationship between governance quality, antibiotic consumption, and AMR across Italian regions.

METHODS

By leveraging data from three distinct sources at the regional level, we compiled a comprehensive dataset comprising: AMR proportions for three specific pathogen-antibiotic combinations in the year 2021, antibiotic consumption data for systemic use in the year 2020, and the 2021 European Quality of Government Index (EQI) and its corresponding pillars. Employing mediation analysis, we investigated the potential mediating role of antibiotic consumption in the association between the EQI and an average measure of AMR.

RESULTS

Our analysis revealed substantial variation in the percentages of AMR across different regions in Italy, demonstrating a discernible North-to-South gradient concerning both antibiotic usage and governance quality. The EQI exhibited a statistically significant negative correlation with both antibiotic consumption and AMR percentages, encompassing both specific combinations and their average value. Regions characterized by higher levels of governance quality consistently displayed lower values of antibiotic consumption and AMR, while regions with lower governance quality tended to exhibit higher levels of antibiotic use and AMR. Furthermore, we observed a significant total effect of the EQI on average AMR (β = - 0.97; CI - 1.51; - 0.43). Notably, this effect was found to be mediated by antibiotic consumption, as evidenced by a significant indirect effect (β = - 0.89; CI - 1.45; - 0.32).

CONCLUSIONS

These findings draw attention to the regional disparities observed in AMR levels, antibiotic consumption patterns, and governance quality in Italy. Our study also highlights the mediating role of antibiotic consumption in the relationship between governance quality and AMR. This underscores the significance of implementing focused interventions and policies aimed at improving governance quality and promoting responsible antibiotic use.

Knowledge and Attitudes of Healthcare Workers towards Antibiotic Use and Antimicrobial Resistance in Two Major Tertiary Hospitals in Western Greece

Antibiotic resistance (ABR) and antimicrobial stewardship arethe two sides of the same coin that constitute a public health hydra. This study aimed to assessthe knowledge and attitude of healthcare workers (HCWs), on antibiotic use and antimicrobial resistance in Western Greece. A total of 200 healthcare workers (doctors, nurses, and others) from the two largest tertiary hospitals in Western Greece were included in our survey. HCWs seem not to decide based on patient opinion in order to prescribe antibiotics. Approximately 97% of them are aware of their main adverse effects. Remarkably, 25% of respondents prescribe antibiotics due to diagnostic uncertainty, and 32.5% of them prescribe antibiotics based on their experience. HCWs statedthat they do not report adverse effects often. Inappropriate antibiotic prescriptions were mentioned as the main reason for bacterial resistance to antimicrobials. Monitoring the patient's treatment progress, using electronic prescriptions, and adhering to international guidelines were suggested as solutions to the problem. Post Hoc analysis showed that nursing staff apply to the national guidelines (p: 0.011) and use electronic prescriptions (p: 0.003) less often compared to consultants, doctor directors, and trainees. The findings of our survey may be useful for the development of future national education programs and interventions thatmay improve healthcare workers' knowledge and ability to manage antibiotics.

Knowledge of healthcare workers to prevent methicillin-resistant Staphylococcus aureus infection in hospitals of Thi-Qar Governorate, Iraq

Methicillin-resistant Staphylococcus aureus (MRSA) infection is considered one of the nosocomial infections that can infect patients and healthcare workers (HCWs) and negatively affect the quality of care provided in the hospital. Evaluate the knowledge of HCWs regarding the prevention of MRSA infection in Thi-Qar Governorate. A descriptive cross-sectional study was conducted for 362 HCWs randomly selected from four hospitals and distributed as follows: 125 from Nasiriyah Teaching Hospital, 80 from Al-Hussein Teaching Hospital, 80 from Al-Haboubi Teaching Hospital and 77 from Souk Al-Shuyoukh General Hospital during the period from October 1 (2022) to May 1 (2023) and data was collected by using self-reported paper-based questionnaires. Our study showed 68.8% of HCWs enjoyed a moderate level of knowledge, and there was a strong correlation (P-value #x003C;0.05), between knowledge and some sociodemographic and occupational characteristics of the participants, which include age, educational level, job title, years of service and workplace in the hospital. Additionally, a relationship between knowledge and the source of the MRAS information was demonstrated which is a highly significant association between the total knowledge score and the sources of information. The knowledge of MRSA infection prevention among HCWs was moderate.

Antimicrobial resistance and rational prescription practices: knowledge, perceptions and confidence of health profession interns in Uganda

Background

Antimicrobial resistance (AMR) is significantly driven by misuse and overuse of antibiotics. Graduate health profession interns often prescribe antimicrobials under minimum supervision.

Objectives

This study explored the knowledge, perceptions and confidence of health profession interns in Uganda regarding AMR and rational prescription practices.

Methods

This was a cross-sectional survey employing quantitative techniques carried out between October and November 2022 at six tertiary hospitals in Uganda. Health profession interns including doctors, nurses, midwives and pharmacists were recruited as study participants. Data were collected using online Kobo toolbox software. Data analysis was performed using STATA (StataCorp) version 16. Bivariate analysis and multivariable logistic regression were performed. P < 0.05 was considered statistically significant.

Results

We recruited 281 participants with a mean age of 27 ± 3.8 years, of which few (n = 53; 19%) had good knowledge about AMR and rational prescription. The use of professional organization guidelines as a source of information was significantly associated with good knowledge (adjusted OR = 1.9; 95% CI: 1.0-3.5; P = 0.046). Nurses had the least knowledge compared with doctors and pharmacists. Continuous medical education (99%) and availability of clinical guidelines (98%) were identified as the most helpful intervention to improve knowledge. Most participants were confident about accurately diagnosing infections and sepsis and selecting appropriate antimicrobials.

Conclusions

Continuous medical education and availability of clinical and professional organization guidelines should be leveraged to improve the knowledge of AMR and rational prescription among health profession interns. Their high confidence in rational prescription practices should be pivotal to the fight against AMR.

The Phytochemical Tactics for Battling Antibiotic Resistance in Microbes: Secondary Metabolites and Nano Antibiotics Methods

One of the most serious threats to human health is antibiotic resistance, which has left the world without effective antibiotics. While continuous research and inventions for new antibiotics are going on, especially those with new modes of action, it is unlikely that this alone would be sufficient to win the battle. Furthermore, it is also important to investigate additional approaches. One such strategy for improving the efficacy of existing antibiotics is the discovery of adjuvants. This review has collected data from various studies on the current crisis and approaches for combating multi-drug resistance in microbial pathogens using phytochemicals. In addition, the nano antibiotic approaches, are discussed, highlighting the high potentials of essential oils, alkaloids, phenolic compounds, and nano antibiotics in combating antibiotic resistance.

Antibiotic Use in Pregnancy: A Global Survey on Antibiotic Prescription Practices in Antenatal Care

Antibiotic prescription and use practices in the antenatal care setting varies across countries and populations and has the potential to significantly contribute to the global spread of antibiotic resistance. This study aims to explore how healthcare practitioners make decisions about antibiotic prescriptions for pregnant women and what factors play a role in this process. A cross-sectional exploratory survey consisting of 23 questions, including 4 free-text and 19 multiple-choice questions, was distributed online. Quantitative data were collected through multiple-choice questions and was used to identify the most common infections diagnosed and the type of antibiotics prescribed. Qualitative data were gathered through free-text answers to identify gaps, challenges, and suggestions, and the data were analyzed using thematic analysis. A total of 137 complete surveys mostly from gynecologists/obstetricians from 22 different countries were included in the analysis. Overall, national and international clinical guidelines and hospital guidelines/protocols were the most frequently used sources of information. This study highlights the crucial role of laboratory results and guidelines at different levels and emphasizes region-specific challenges and recommendations. These findings underscore the pressing need for tailored interventions to support antibiotic prescribers in their decision-making practice and to address emerging resistance.

Perceptions, attitudes, and practices of a Belgian teaching hospital's physicians, pharmacists, and nurses regarding antibiotic use and resistance: survey towards targeted actions for Antimicrobial Stewardship

OBJECTIVES

This study aimed to identify barriers to the proper use of antibiotics by healthcare professionals and to help the hospital Antimicrobial Stewardship develop suitable actions for the staff.

METHODS

In a Belgian teaching hospital, a survey was conducted among physicians, pharmacists, and nurses involved in antibiotherapy. Questions from the 2019 European Center for Disease Prevention and Control (ECDC) survey were analyzed based on components of the COM-B model (capabilities, opportunities, and motivations). First, collected data were reviewed with the Ethnos software to analyze the different COM-B model components. For statistical analyses, responses were grouped into three clear-cut answers in a Fisher's exact test.

RESULTS

Overall, 400 staff members were included. We found that our professions, combined, have a good perception of antibiotic resistance (97.8%). For capabilities, however, only 77.2% state that they have sufficient knowledge, with 91.3%, 71.5%, and 63.0% for physicians, nurses, and pharmacists, respectively. For opportunities (access to resources, information, and training), it is observed that 72.2% report having easy access to the guidelines they need to manage infections. In comparison, for 64.2% of the respondents, this information changed their opinion on the useless or inappropriate prescription, administration, and delivery of antibiotics. For 55.0%, this information has enabled them to change their practices. Finally, for motivations, 92.8% of respondents state that they know about the link between their practices and the emergence and spread of antibiotic resistance. However, only 65.0% of participants say they have a role in managing antibiotic resistance. We found that 5 out of 8 questions are significantly dependent on the profession: 2 inquiries related to capability, 1 to opportunity, and 2 to motivation.

CONCLUSION

We found that responses to the ECDC questionnaire are related to the profession. While some topics are universal/cross-functional, others must be explicitly tailored to each professional category. Information is useless if not accessible. Communication and provision of documents are thus paramount.

How Antimicrobial Resistance Is Linked to Climate Change: An Overview of Two Intertwined Global Challenges

Globally, antimicrobial resistance (AMR) and climate change (CC) are two of the top health emergencies, and can be considered as two interlinked public health priorities. The complex commonalities between AMR and CC should be deeply investigated in a One Health perspective. Here, we provided an overview of the current knowledge about the relationship between AMR and CC. Overall, the studies included pointed out the need for applying a systemic approach to planetary health. Firstly, CC increasingly brings humans and animals into contact, leading to outbreaks of zoonotic and vector-borne diseases with pandemic potential. Although it is well-established that antimicrobial use in human, animal and environmental sectors is one of the main drivers of AMR, the COVID-19 pandemic is exacerbating the current scenario, by influencing the use of antibiotics, personal protective equipment, and biocides. This also results in higher concentrations of contaminants (e.g., microplastics) in natural water bodies, which cannot be completely removed from wastewater treatment plants, and which could sustain the AMR spread. Our overview underlined the lack of studies on the direct relationship between AMR and CC, and encouraged further research to investigate the multiple aspects involved, and its effect on human health.

A questionnaire based survey among pharmacy practitioners to evaluate the level of knowledge and confidence towards antimicrobial stewardship

Objective

Our study aimed to assess the knowledge, understanding and confidence of the practicing pharmacists in UAE as an antimicrobial Stewards. Antimicrobial resistance threatens the achievements of modern medicine globally, and it's highly required for the AMS principles to be implemented in our communities.

Methods

A cross-sectional online- questionnaire based survey was used among UAE pharmacy practitioners from different areas of practice who are holding pharmaceutical degrees and/or licensed pharmacists. The questionnaire was sent to the participants via social media platforms. The questionnaire was validated, and reliability assessment was made prior to the conduct.

Results

A total of 117 pharmacists responded to this study, out of which (70.9%, n=83) were females. Pharmacists which are from various practice fields participated in the survey, but the majority were pharmacists in Hospital pharmacies or Clinical pharmacists (47%, n=55), also community pharmacists (35.9%, n=42), while only (16.9%, n=20) ware from other areas of pharmacy including industrial pharmacy and academia. The majority of participants 88.9% (n= 104) were interested in pursuing their career as an Infectious disease pharmacist or getting a certificate in antimicrobial stewardship. The mean scores in the knowledge towards antimicrobial resistance was 3.75 (poor: 1-1.6, moderate: 1.7-3.3.

Good

3.4-5), indicates that the pharmacists have a good level of knowledge towards AMR. A total of 84.3% of participants succeeded in Identifying the correct intervention for antibiotic resistance. The findings also showed that the total mean score of hospital pharmacists (mean=10.6±1.12), and the average of the scores of community pharmacists (mean=9.8±1.38), were non-significant between the different area of practice. 52.3% of the participants had a training on antimicrobial stewardship during their experiential rotation which reflected on their confidence in their performance and knowledge assessment (p value < 0.05).

Conclusion

The study concluded good knowledge and high confidence levels among practicing pharmacists in UAE. However, the findings also identify areas of improvement in the practicing pharmacist, and the significant relationship between the knowledge and confidence scores reflects the ability of the practicing pharmacists to integrate the AMS principles within the UAE, which aligns with the attainability of the improvement.

Investigating Knowledge of Antibiotics, Antimicrobial Resistance and Antimicrobial Stewardship Concepts Among Final Year Undergraduate Pharmacy Students in Northern Nigeria

Introduction

Well trained, knowledgeable and competent pharmacists are indispensable in the fight against antimicrobial resistance (AMR), which is a current global public health problem. The aim of this work was to assess knowledge of antibiotics, antimicrobial resistance and antimicrobial stewardship of fifth year pharmacy students at three universities in Northern Nigeria.

Methods

A descriptive cross-sectional study that used a paper-based questionnaire to collect data from July to September 2021 was conducted. The questionnaire was self-administered and divided into four sections. The first section collected information about the demographic data of respondents, while section B explored their knowledge of antibiotics and AMR. Section C contained six questions assessing knowledge of various aspects of antimicrobial stewardship (AMS), while the final part assessed respondents' preparedness to work with antibiotics and perceptions of their current knowledge of these concepts. Descriptive statistics were used to report the results obtained.

Results

A total of 164 questionnaires were retrieved. Majority of respondents were male (58.3%) and aged between 21 and 25 years (53.4%). Most of them had some knowledge of antibiotics and AMR, however several misconceptions with respect to these concepts were identified. Only 80 (48.8%) of respondents indicated that they knew what AMS was, although most of these students were correctly knowledgeable about the goals and scope of AMS and composition of the AMS team. Generally, less than half of respondents agreed that their current knowledge of antibiotics, AMR or AMS was adequate for their future careers, and over 90% of them agreed that they would like more education about these topics.

Conclusion

Many of the study's' respondents were somewhat knowledgeable about these concepts, although several knowledge gaps were also observed. Improving undergraduate pharmacy education with respect to these concepts is recommended.

What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review

BACKGROUND

Antimicrobial resistance issues, and the consequent demand for antimicrobial stewardship (AMS) programs, need to be investigated urgently and clearly. Considering the large amount of time nurses spend at patients' bedside, the aim of the present study was to examine recent literature on nursing competency in AMS.

METHODS

Drawing from Tricco and colleagues' seven-stage process, a rapid review was performed. MEDLINE, CINAHL and EMBASE databased were searched from December 1st, 2019 until December 31st, 2021. Article screening and study selection were conducted independently by three reviewers. Data were analyzed narratively and categorized adopting an inductive thematic coding.

RESULTS

Sixteen studies met the inclusion criteria and were included. Publications were mainly authored in USA (n = 4), Australia and New Zealand (n = 4) and Asia (n = 4), followed by Europe (n = 2) and Africa (n = 2). Ten studies were quantitative in design, followed by qualitative (n = 4) and mixed-methods studies (n = 2). Nursing competency in AMS seems to be influenced by a two-dimensional model: on the one hand, internal factors which consisted in knowledge, attitudes and practices and, on the other hand, external aspects which are at environmental level in terms of structures and processes.

CONCLUSION

This study provided a map of dimensions for researchers and practitioners to consider when planning clinical governance, educational activities, and research programs. Significant opportunities exist for nurses to contribute to practice, education, research, and policy efforts aimed at reducing antimicrobial resistance.

A questionnaire based survey among pharmacy practitioners to evaluate the level of knowledge and confidence towards antimicrobial stewardship

Objective

Our study aimed to assess the knowledge, understanding and confidence of the practicing pharmacists in UAE as an antimicrobial Stewards. Antimicrobial resistance threatens the achievements of modern medicine globally, and it's highly required for the AMS principles to be implemented in our communities.

Methods

A cross-sectional online- questionnaire based survey was used among UAE pharmacy practitioners from different areas of practice who are holding pharmaceutical degrees and/or licensed pharmacists. The questionnaire was sent to the participants via social media platforms. The questionnaire was validated, and reliability assessment was made prior to the conduct.

Results

A total of 117 pharmacists responded to this study, out of which (70.9%, n=83) were females. Pharmacists which are from various practice fields participated in the survey, but the majority were pharmacists in Hospital pharmacies or Clinical pharmacists (47%, n=55), also community pharmacists (35.9%, n=42), while only (16.9%, n=20) ware from other areas of pharmacy including industrial pharmacy and academia. The majority of participants 88.9% (n= 104) were interested in pursuing their career as an Infectious disease pharmacist or getting a certificate in antimicrobial stewardship. The mean scores in the knowledge towards antimicrobial resistance was 3.75 (poor: 1-1.6, moderate: 1.7-3.3, Good: 3.4-5), indicates that the pharmacists have a good level of knowledge towards AMR. A total of 84.3% of participants succeeded in Identifying the correct intervention for antibiotic resistance. The findings also showed that the total mean score of hospital pharmacists (mean=10.6±1.12), and the average of the scores of community pharmacists (mean=9.8±1.38), were non-significant between the different area of practice. 52.3% of the participants had a training on antimicrobial stewardship during their experiential rotation which reflected on their confidence in their performance and knowledge assessment (p value < 0.05).

Conclusion

The study concluded good knowledge and high confidence levels among practicing pharmacists in UAE. However, the findings also identify areas of improvement in the practicing pharmacist, and the significant relationship between the knowledge and confidence scores reflects the ability of the practicing pharmacists to integrate the AMS principles within the UAE, which aligns with the attainability of the improvement.

A national online survey of Filipinos' knowledge, attitude, and awareness of antibiotic use and resistance: A cross-sectional study

BACKGROUND

Antibiotic resistance is one of the 21st century's most challenging clinical and public health issues. However, this health issue remains underreported in the Philippines.

AIM

This study examined Filipinos' knowledge, attitude, and awareness regarding antibiotic use and resistance and the associated predictive variables of antibiotic resistance.

METHODS

A cross-sectional design and Strengthening the Reporting of Observational Studies in Epidemiology guidelines were used in this study. Convenience sampling of 3767 participants completed the Eurobarometer survey on antibiotic resistance from October 2021 to February 2022. χ² and regression analysis were used to analyze the data.

RESULTS

Most participants were familiar with the popular types of available antibiotics. Males and healthcare workers had a higher percentage of correct responses on antibiotic resistance knowledge. Participants had moderate to high knowledge levels of antibiotic resistance. Age, educational attainment, profession, antibiotic use in the previous year, and household members taking antibiotics were significant predictors of the level of knowledge of antibiotic resistance. There was a significant difference in participants' sex, age, and educational attainment in their attitudes toward acquisition, hygienic practices, and the role of health professionals in antibiotic resistance.

CONCLUSION

Government agencies and policymakers should consider the identified predictors when establishing policies on antibiotic resistance. This will ensure that antibiotic use is safe and effective.

Attitudes towards Antibiotic Prescription and Antimicrobial Resistance Awareness among Italian Dentists: What Are the Milestones?

Antimicrobial resistance is a growing phenomenon, often associated with the improper prescription of antibiotics, prescribed by those who do not follow the guidelines for antibiotic stewardship. The aim of this study was to evaluate the current attitude towards antibiotic prescribing and antimicrobial resistance awareness among Italian dentists. An online questionnaire was distributed to Italian dentists from September to December 2021. The questionnaire was composed of three main sections. The first part was focused on demographic characteristics, the second part on prescription habits, and the third part on the dentists’ knowledge regarding the phenomenon of antimicrobial resistance. A chi-square test was used to find associations between different variables. The level of significance was set at p < 0.05. A total of 382 dentists completed the questionnaire. The main reasons for antibiotic prescribing were for abscesses (39.6%), extractions (24.5%), and pulpitis (14.1%). The majority of participants (85.3%) reported prescribing macrolides in the case of a penicillin allergy. Most dentists (98.9%) were aware of the antimicrobial resistance phenomenon, but only 7.4% of them consulted the guidelines for prescribing antibiotics. This study demonstrates that the same trend exists in Italy as in other countries in terms of the high prevalence of misuse and overuse of antibiotics, and that Italian dentists utilize a range of antibiotic management strategies.

Polish Medical Doctors’ Opinions on Available Resources and Information Campaigns concerning Antibiotics and Antibiotic Resistance, a Cross-Sectional Study

Background: Antibiotic resistance (ABR) is at the top of global health threats. This paper aims to assess Polish physicians’ readiness to impact ABR through prescribing routines. Methods: Surveying Polish physicians participating in specialization courses at the Center for Postgraduate Medical Education in Warsaw, Poland from October 2019 to March 2020. Results: Information was obtained from 504 physicians aged 25–59, mean 32.8 ± 5.9 years, mainly women (65%). Most doctors (78%) prescribed antibiotics at least once a week. Physicians indicated clinical practice guidelines as resources most often consulted in the management of infections (90%). However, clinical experience was also declared a powerful resource. In total, 54% of respondents recalled receiving information about the prudent use of antibiotics within 12 months, which partially translated into changing views (56%) and practice (42%). Physicians disagreed that national campaigns provide good promotion of prudent antibiotics use (75%) or that they are effective (61%). Only 40% of doctors were aware of the national campaign promoting responsible antibiotics use, 24% had heard about the European Antibiotic Awareness Day and 20% knew about the World Antimicrobial Awareness Week. Conclusions: Prescribers most often rely on clinical practice guidelines and their own experience as resources for antibiotics use. Doctors’ awareness of available resources and information campaigns concerning antibiotics and antibiotic resistance should be improved.

The Inverse Relationship between Influenza Vaccination and Antimicrobial Resistance: An Ecological Analysis of Italian Data

Antimicrobial resistance (AMR) is one of the key threats to global health and requires sustainable and effective actions to reduce its consequences in the near future worldwide. There are several well-documented and epidemiologically supported examples that both bacterial and viral vaccines might have an impact on AMR. Here, we conducted an ecological analysis of Italian data to evaluate the relationship between influenza vaccination coverage and AMR proportions over the last two decades. We found significant negative correlations between influenza vaccination coverage in the population over 64 years and AMR in Escherichia coli and Klebsiella pneumoniae isolates. The observed inverse relationships were confirmed by linear regression analysis. Similar results were obtained for the vaccination coverage in the overall population. Despite the main limitations of our study, its findings suggested an inverse relationship between influenza vaccination coverage and AMR proportions over the years, which was in accordance with previous theories illustrating how influenza vaccination reduced antibiotic prescriptions. However, since our study did not allow for us to elucidate the mechanisms underpinning the observed relationship, more and better data on confounding and mediating factors should be considered in future research.

Knowledge and Practice of Antibiotic Management and Prudent Prescribing among Polish Medical Doctors

Antimicrobial resistance (AMR) is an urgent public health issue. The role of medical doctors in proper antibiotic use is crucial. The aim of this study was to evaluate the knowledge and practices of Polish doctors of antimicrobial prescribing and antibiotic resistance. The study group consisted of 504 medical doctors with an average age 32.8 ± 5.9 years, mostly women (65%). The paper questionnaire was developed on the basis of a survey tool developed by the European Centre for Disease Prevention and Control (ECDC) and Public Health England (PHE). According to our study, physicians were aware that: taking antibiotics has side effects, antibiotics cannot be used against viruses, unnecessary use of antibiotics leads to AMR and that healthy people can carry resistant bacteria (each item ≥98% correct responses). Only 47% of respondents knew that the use of antibiotics as growth stimulants in livestock is illegal in the EU. Of the respondents, 98.61% saw the connection between prescribing antibiotics and AMR. However, 65.28% of the respondents reported a lack of appropriate materials on AMR counseling. Nearly 92.5% of participants “never” or “rarely” gave out resources on prudent antibiotic use. Physicians in Poland underestimate the role of hand hygiene in stimulating antibiotic resistance (ABR) (74.4%), while demonstrating satisfying knowledge about antimicrobial use, the clinical application of antimicrobial guidelines and prevention of ABR. However, educational interventions are needed to help lead challenging communication with assertive patients. Appropriate patient resources would be helpful in reaching this goal.

How COVID-19 Has Influenced Public Interest in Antimicrobials, Antimicrobial Resistance and Related Preventive Measures: A Google Trends Analysis of Italian Data

Google Trends analytics is an innovative way to evaluate public interest in antimicrobial resistance (AMR) and related preventive measures. In the present study, we analyzed Google Trends data in Italy, from 2016 to 2021. A joinpoint analysis was performed to assess whether and how annual campaigns and the COVID-19 pandemic affected public interest in antimicrobials, AMR, hand hygiene, and the use of disinfectant. For the terms “antimicrobials” and “antimicrobial resistance”, no joinpoints were detected around the time of the World Antimicrobial Awareness Week. Similarly, the COVID-19 pandemic seems to have had no effect on public interest in this term. For the term “handwashing”, no joinpoints were detected around World Hand Hygiene Day or Global Handwashing Day. However, three joinpoints were detected around the peak of interest observed in March 2020, after the beginning of the COVID-19 pandemic. Comparable results were obtained for the term “disinfectant”. These findings show that the influence of annual campaigns on public interest in AMR and preventive measures was modest and not long-term. The COVID-19 pandemic, meanwhile, had no effect on AMR but raised awareness on preventive measures. However, this was a temporary rather than long-term outcome. Thus, different policies, strategies, and measures should be designed to advocate prevention of AMR in the COVID-19 era.