Srinivasan Arjun, Song Xiaoyan, Richards Ann, Sinkowitz-Cochran Ronda, Cardo Denise, Rand Cynthia
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. 30333, USA.
Arch Intern Med. 2004 Jul 12;164(13):1451-6. doi: 10.1001/archinte.164.13.1451.
Examination of knowledge, attitudes, and beliefs of house staff physicians will be important in developing interventions to improve antimicrobial use and prevent resistance.
A 75-item survey was distributed to house staff physicians on nonpediatric services in a university teaching hospital. Knowledge was assessed with a 10-question quiz.
The survey was completed by 179 (67%) of 269 house staff physicians on 5 specialties. Outside and inside the intensive care unit, 21% and 25% of respondents, respectively, reported that they were using antibiotics optimally. Surgeons were significantly more likely than other physicians to report that they were regularly seeking input into antimicrobial selections (P<.001). Of the 170 physicians who completed the survey, 88% agreed antibiotics are overused in general and 72% also agreed this was the case at their institution (r = 0.56; P<.05); 96% agreed that hospitals in general face serious problems with antibiotic resistance and 93% agreed that their hospital faces these same problems (r = 0.57; P<.05); 97% agreed that better use of antibiotics would reduce resistance; 32% stated that they had not had formal teaching on antimicrobial agents in the last year (medicine residents reported significantly more formal teaching than others [P =.001]); and 90% wanted more education about antimicrobials and 67% wanted more feedback on antimicrobial selections. The mean antimicrobial quiz score was 28%, with medicine residents scoring significantly higher than others (P =.04). Upper-level residents did not perform better than interns.
This survey (1) revealed that house staff are aware of the importance of antimicrobial resistance and believe better antimicrobial use will help this problem and (2) demonstrated differences between specialties with respect to antimicrobial use and knowledge. House staff at our hospital have suboptimal knowledge about antimicrobials, and this knowledge did not increase appreciably over the course of their training. Antimicrobial education is needed and is likely to be well received by house staff physicians in academic centers but may be more effective if it is tailored to specific specialties.
了解住院医师的知识、态度和信念对于制定改善抗菌药物使用及预防耐药性的干预措施至关重要。
向一所大学教学医院非儿科科室的住院医师发放了一份包含75个条目的调查问卷。通过一个有10道题的小测验评估知识水平。
269名来自5个专业的住院医师中有179名（67%）完成了调查。在重症监护病房外和病房内，分别有21%和25%的受访者表示他们正在优化使用抗生素。外科医生比其他医生更有可能报告他们在抗菌药物选择方面经常寻求建议（P<0.001）。在完成调查的170名医生中，88%同意抗生素总体上被过度使用，72%也同意在他们所在机构情况也是如此（r = 0.56；P<0.05）；96%同意医院总体上面临抗生素耐药性的严重问题，93%同意他们的医院也面临同样的问题（r = 0.57；P<0.05）；97%同意更好地使用抗生素会降低耐药性；32%表示他们在过去一年没有接受过关于抗菌药物的正规教学（内科住院医师报告接受的正规教学明显多于其他住院医师[P = 0.001]）；90%希望获得更多关于抗菌药物的教育，67%希望在抗菌药物选择方面获得更多反馈。抗菌药物小测验的平均得分是28%，内科住院医师的得分明显高于其他住院医师（P = 0.04）。高年级住院医师的表现并不比实习医师好。
这项调查（1）表明住院医师意识到抗菌药物耐药性的重要性，并认为更好地使用抗菌药物将有助于解决这一问题，（2）显示了各专业在抗菌药物使用和知识方面的差异。我院住院医师对抗菌药物的知识掌握欠佳，且在培训过程中这一知识并未明显增加。需要进行抗菌药物教育，在学术中心可能会受到住院医师的欢迎，但如果针对特定专业进行调整可能会更有效。
