Broom Jennifer K, Broom Alex F, Kirby Emma R, Gibson Alexandra F, Post Jeffrey J
Sunshine Coast University Hospital, Birtinya, QLD, Australia; University of Queensland, QLD, Australia.
School of Social Sciences, University of New South Wales, Sydney, NSW, Australia.
Am J Infect Control. 2017 Aug 1;45(8):911-916. doi: 10.1016/j.ajic.2017.03.003. Epub 2017 Apr 3.
The treatment of pulmonary infections is one of the largest indications for antibiotics in human health care, offering significant potential for antibiotic optimization internationally. This study explores the perspectives of pulmonary clinicians on antibiotic use in hospital pulmonary infections.
Twenty-eight pulmonary doctors and nurses from 2 hospitals participated in semi-structured interviews focusing on their experiences of antibiotic use.
Barriers to antibiotic optimization in pulmonary infections were identified. Clinical barriers are as follows. The first is differentiating pneumonia vs chronic obstructive pulmonary disease: differentiating pulmonary diagnoses was reported as challenging, leading to overtreatment. The second is differentiating viral vs bacterial: diagnostic differentiation was perceived to contribute to excess antibiotic use. The third is differentiating colonization vs pathogen: the interpretation of ambiguous results was reported to lead to under- or overprescribing depending on the perspective of the treating team. Social barriers are as follows. The first is the perception of resistance: antibiotic resistance was not perceived as an immediate threat. The second is the perceived value of antibiotic clinical guidelines: there was mistrust in antibiotic guidelines. The third is hospital hierarchies: hierarchical structures had a significant influence on prescribing.
Substantial barriers to antibiotic optimization in pulmonary infections were identified. To facilitate change in antibiotic use there must be a systematic understanding and interventions to address specific clinical issues. In the case of pulmonary medicine, significant identified issues, such as mistrust in clinical guidelines and diagnostic challenges, need to be addressed.
肺部感染的治疗是人类医疗保健中抗生素使用的最大适应症之一，在国际上具有显著的抗生素优化潜力。本研究探讨了肺部临床医生对医院肺部感染中抗生素使用的看法。
来自2家医院的28名肺部医生和护士参与了以他们抗生素使用经验为重点的半结构化访谈。
确定了肺部感染中抗生素优化的障碍。临床障碍如下。首先是区分肺炎与慢性阻塞性肺疾病：据报道，区分肺部诊断具有挑战性，导致过度治疗。其次是区分病毒感染与细菌感染：诊断区分被认为导致了抗生素的过度使用。第三是区分定植与病原体：据报道，对不明确结果的解读会导致根据治疗团队的观点出现处方不足或过度处方的情况。社会障碍如下。首先是对抗生素耐药性的认知：抗生素耐药性未被视为直接威胁。其次是对抗生素临床指南的认知价值：对抗生素指南存在不信任。第三是医院层级：层级结构对处方有重大影响。
确定了肺部感染中抗生素优化的重大障碍。为了促进抗生素使用的改变，必须有系统的理解和干预措施来解决特定的临床问题。就肺病而言，需要解决已确定的重大问题，如对临床指南的不信任和诊断挑战。
