García Coralith, Llamocca Liz P, García Krystel, Jiménez Aimee, Samalvides Frine, Gotuzzo Eduardo, Jacobs Jan
Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú.
BMC Clin Pharmacol. 2011 Nov 15;11:18. doi: 10.1186/1472-6904-11-18.
Misuse of antimicrobials (AMs) and antimicrobial resistance (AMR) are global concerns. The present study evaluated knowledge, attitudes and practices about AMR and AM prescribing among medical doctors in two large public hospitals in Lima, Peru, a middle-income country.
Cross-sectional study using a self-administered questionnaire
A total of 256 participants completed the questionnaire (response rate 82%). Theoretical knowledge was good (mean score of 6 ± 1.3 on 7 questions) in contrast to poor awareness (< 33%) of local AMR rates of key-pathogens. Participants strongly agreed that AMR is a problem worldwide (70%) and in Peru (65%), but less in their own practice (22%). AM overuse was perceived both for the community (96%) and the hospital settings (90%). Patients' pressure to prescribing AMs was considered as contributing to AM overuse in the community (72%) more than in the hospital setting (50%). Confidence among AM prescribing was higher among attending physicians (82%) compared to residents (30%, p < 0.001%). Sources of information considered as very useful/useful included pocket-based AM prescribing guidelines (69%) and internet sources (62%). Fifty seven percent of participants regarded AMs in their hospitals to be of poor quality. Participants requested more AM prescribing educational programs (96%) and local AM guidelines (92%).
This survey revealed topics to address during future AM prescribing interventions such as dissemination of information about local AMR rates, promoting confidence in the quality of locally available AMs, redaction and dissemination of local AM guidelines and addressing the general public, and exploring the possibilities of internet-based training.
抗菌药物的滥用和抗菌药物耐药性是全球关注的问题。本研究评估了秘鲁利马两家大型公立医院的医生对抗菌药物耐药性及抗菌药物处方的知识、态度和行为,秘鲁是一个中等收入国家。
采用自填式问卷进行横断面研究。
共有256名参与者完成了问卷(回复率82%)。理论知识掌握良好(7个问题的平均得分为6±1.3),但对关键病原体的当地抗菌药物耐药率知晓率较低(<33%)。参与者强烈认同抗菌药物耐药性在全球(70%)和秘鲁(65%)是个问题,但在他们自己的临床实践中则较少(22%)。社区(96%)和医院环境(90%)中都存在抗菌药物过度使用的现象。患者要求开具抗菌药物的压力被认为是社区抗菌药物过度使用的原因(72%),高于医院环境(50%)。与住院医师(30%,p<0.001%)相比,主治医师对抗菌药物处方的信心更高(82%)。被认为非常有用/有用 的信息来源包括基于口袋书的抗菌药物处方指南(69%)和互联网来源(62%)。57%的参与者认为他们医院的抗菌药物质量较差。参与者要求开展更多抗菌药物处方教育项目(96%)和当地抗菌药物指南(92%)。
本次调查揭示了未来抗菌药物处方干预措施中需要解决的问题,如传播当地抗菌药物耐药率信息、增强对当地可得抗菌药物质量的信心、编写和传播当地抗菌药物指南并向公众宣传,以及探索基于互联网培训的可能性。