Steinberg Marilyn, Dresser Linda D, Daneman Nick, Smith Orla M, Matte Andrea, Marinoff Nicole, Bell Chaim M, Morris Andrew M
Mount Sinai Hospital, Toronto, Canada
University Health Network, Toronto, Canada Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
J Intensive Care Med. 2016 Jan;31(1):61-5. doi: 10.1177/0885066614541922. Epub 2014 Jul 8.
Antimicrobial stewardship is a process designed to optimize antimicrobial therapy by ensuring patients get the right antimicrobials at the right dose and at the right time. Antimicrobial stewardship programs (ASPs) are increasingly being implemented in health care institutions, are required by some accreditation bodies, and have the potential for maximum impact in intensive care units (ICUs). We administered a survey to critical care physicians across Canada to better understand their knowledge, attitudes, and perceptions on the utility of ASPs in improving patient care.
DESIGN, SETTING, AND PATIENTS: We distributed a Web-based survey to physicians who attend in Canadian ICUs. Respondents were identified through the membership lists of multiple critical care organizations. Content validity, utility, clarity, and test-retest reliability were evaluated prior to distribution. Survey items assessed ASP knowledge, attitudes, and experiences. Attitudes toward ASPs were assessed on a 5-point Likert-type scale.
The survey was completed by 185 physicians, with a response rate of 29% (n = 185/634) for all physicians contacted. A majority (74%) of respondents reported that there was at least 1 component of an ASP at their institution. Most (86%) respondents agreed or strongly agreed that the patients in their ICU benefit from an ASP, with 81% reporting the ASP increases their knowledge of appropriate antimicrobial use in the ICU setting. Only 11% of respondents reported they felt that time spent interacting with the ASP team was an inefficient use of their time, and only 7% expressed concern that the ASP negatively affected their autonomy.
Based on our survey results, Canadian intensivists are supportive of antimicrobial stewardship in ICUs and feel that ASPs provide a valuable service to both patients and clinicians.
抗菌药物管理是一个旨在通过确保患者在正确的时间、以正确的剂量获得正确的抗菌药物来优化抗菌治疗的过程。抗菌药物管理计划（ASP）在医疗机构中越来越多地得到实施，一些认证机构也有相关要求，并且在重症监护病房（ICU）中具有产生最大影响的潜力。我们对加拿大各地的重症监护医生进行了一项调查，以更好地了解他们对ASP在改善患者护理方面的效用的知识、态度和看法。
设计、背景和患者：我们向在加拿大ICU工作的医生分发了一份基于网络的调查问卷。通过多个重症监护组织的成员名单确定受访者。在分发之前，对内容效度、效用、清晰度和重测信度进行了评估。调查项目评估了ASP的知识、态度和经验。对ASP的态度采用5点李克特量表进行评估。
185名医生完成了调查，所有联系的医生的回复率为29%（n = 185/634）。大多数（74%）受访者报告称，他们所在机构至少有一个ASP组件。大多数（86%）受访者同意或强烈同意他们ICU的患者从ASP中受益，81%的受访者报告称ASP增加了他们在ICU环境中正确使用抗菌药物的知识。只有11%的受访者表示，他们认为与ASP团队互动所花费的时间是对时间的低效利用，只有7%的人担心ASP会对他们的自主权产生负面影响。
根据我们的调查结果，加拿大的重症监护医生支持ICU中的抗菌药物管理，并认为ASP为患者和临床医生都提供了有价值的服务。
