Papanicolas Lito E, Nelson Renjy, Warner Morgyn S
Department of Infectious Diseases, The Queen Elizabeth Hospital, Level 2C, 28 Woodville Road, Woodville, South Australia 5011, Australia.
Microbiology and Infectious Diseases Directorate, SA Pathology, Frome Road, Adelaide, South Australia 5000, Australia.
J Antimicrob Chemother. 2017 Apr 1;72(4):1202-1205. doi: 10.1093/jac/dkw525.
Inappropriate antimicrobial use drives antimicrobial resistance and is a global public health problem. This study examined whether withholding antimicrobial susceptibilities in combination with interpretive comments on microbiological reports influenced the decision to inappropriately prescribe antibiotics in a controlled survey.
Seventy junior doctors attending educational sessions were given one of two surveys describing four clinical case vignettes (scenarios) in which antimicrobial treatment was not indicated. They were asked to select their preferred treatment from multiple choices. In the scenarios labelled 'A', the laboratory report did not report antibiotic susceptibilities, but included comments from the microbiologist. In the scenarios labelled 'B', the laboratory report included full organism identification and susceptibility results without additional comments.
For scenarios 1, 2 and 3 there was a significantly higher probability ( P < 0.01) that the doctor selected an answer involving antibiotic treatment if he/she received the 'B' version of the scenario where reports included antimicrobial susceptibilities, but no interpretive comments. This was significant in both interns and more senior doctors. In scenario 4, of which there were two versions, there was no difference seen in the answers between the groups given scenario A or B.
The results of this survey suggest that withholding antimicrobial susceptibility results in combination with interpretive comments on microbiology reports significantly influences the decision of junior doctors to prescribe antibiotics in low-acuity outpatient setting scenarios (represented in scenarios 1-3), but not in inpatient scenarios (represented in scenario 4).
不恰当的抗菌药物使用会导致抗菌药物耐药性，这是一个全球性的公共卫生问题。本研究在一项对照调查中检验了在微生物学报告中不提供抗菌药物敏感性结果并结合解释性评论是否会影响不恰当开具抗生素的决定。
70名参加教育课程的初级医生被给予两项调查中的一项，这两项调查描述了四个临床病例 vignettes（情景），在这些情景中不建议使用抗菌药物治疗。要求他们从多个选项中选择自己偏好的治疗方法。在标记为“A”的情景中，实验室报告未报告抗生素敏感性，但包括微生物学家的评论。在标记为“B”的情景中，实验室报告包括完整的病原体鉴定和敏感性结果，没有额外评论。
在情景1、2和3中，如果医生收到报告包含抗菌药物敏感性但无解释性评论的“B”版情景，那么他们选择涉及抗生素治疗答案的概率显著更高（P < 0.01）。这在实习医生和更资深的医生中都很显著。在情景4（有两个版本）中，给予情景A或B的两组答案之间没有差异。
这项调查的结果表明，在微生物学报告中不提供抗菌药物敏感性结果并结合解释性评论，会显著影响初级医生在低 acuity 门诊情景（情景1 - 3所代表）中开具抗生素的决定，但在住院情景（情景4所代表）中则不然。
