Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Université de Lorraine, EA 4360 APEMAC, Nancy, France.
Clin Microbiol Infect. 2019 Jan;25(1):48-53. doi: 10.1016/j.cmi.2018.04.031. Epub 2018 May 17.
We aimed to assess patient-related determinants potentially influencing antibiotic use.
Studies published in MEDLINE until 30 September 2015 were searched. We included: qualitative studies describing patients' self-reported determinants of antibiotic use; and quantitative studies on either self-reported or objectively assessed determinants associated with antibiotic use. Whenever possible, reported determinants were categorized as 'barriers' or 'facilitators' of responsible antibiotic use.
A total of 87 studies from 33 countries were included. Seventy-five (86.2%) were quantitative and described self-reported (45/75, 60.0%), objectively assessed (20/75, 26.7%) or self-reported and objectively assessed (10/75, 13.3%) patient-related determinants. Twelve (12/87, 13.8%) were qualitative studies or had a qualitative and quantitative component. Eighty-six of the studies (98.8%) concerned the outpatient setting. We identified seven broad categories of determinants having an impact on different aspects of antibiotic use (in descending order of frequency): demographic and socio-economic characteristics, patient-doctor interactions (e.g. counselling), treatment characteristics (e.g. administration frequency), attitudes (e.g. expecting antibiotics), access to treatment (e.g. patients' direct costs), characteristics of the condition for which the antibiotic was prescribed (e.g. duration of symptoms), knowledge (e.g. regarding indications for treatment). Most determinants were classified as 'barriers' to responsible antibiotic use.
A large variety of patient-related determinants impact antibiotic use. The most easily 'modifiable' determinants concern patient-doctor interactions, treatment characteristics and knowledge. Data from the inpatient setting and low- and middle-income countries were underrepresented. Further studies should develop and test interventions that take these determinants into account with the ultimate aim of improving responsible use of antibiotics.
评估可能影响抗生素使用的患者相关决定因素。
检索截至 2015 年 9 月 30 日在 MEDLINE 上发表的研究。我们纳入了：描述患者自我报告的抗生素使用决定因素的定性研究；以及与抗生素使用相关的自我报告或客观评估的决定因素的定量研究。只要有可能，报告的决定因素被归类为负责任使用抗生素的“障碍”或“促进因素”。
来自 33 个国家的 87 项研究被纳入。其中 75 项（86.2%）为定量研究，描述了自我报告（45/75，60.0%）、客观评估（20/75，26.7%）或自我报告和客观评估（10/75，13.3%）的患者相关决定因素。12 项（12/87，13.8%）为定性研究或具有定性和定量部分。86 项研究（98.8%）为门诊研究。我们确定了影响抗生素使用不同方面的七个广泛类别的决定因素（按出现频率降序排列）：人口统计学和社会经济特征、医患互动（如咨询）、治疗特征（如给药频率）、态度（如期待抗生素）、治疗可及性（如患者的直接费用）、开处抗生素的疾病特征（如症状持续时间）、知识（如治疗指征）。大多数决定因素被归类为负责任使用抗生素的“障碍”。
大量的患者相关决定因素影响抗生素的使用。最容易“改变”的决定因素涉及医患互动、治疗特征和知识。来自住院环境和中低收入国家的数据代表性不足。进一步的研究应开发和测试考虑这些决定因素的干预措施，以最终改善抗生素的合理使用。
