Sunshine Coast University Hospital, Birtinya, QLD, Australia.
University of Queensland, Brisbane, QLD, Australia.
J Antimicrob Chemother. 2019 Sep 1;74(9):2803-2809. doi: 10.1093/jac/dkz233.
Significant antimicrobial overuse persists worldwide, despite overwhelming evidence of antimicrobial resistance and knowledge that optimization of antimicrobial use will slow the development of resistance. It is critical to understand why this occurs. This study aims to consider the social influences on antimicrobial use within hospitals in Australia, via an in-depth, multisite analysis.
We used a qualitative multisite design, involving 222 individual semi-structured interviews and thematic analysis. Participants (85 doctors, 79 nurses, 31 pharmacists and 27 hospital managers) were recruited from five hospitals in Australia, including four public hospitals (two metropolitan, one regional and one remote) and one private hospital.
Analysis of the interviews identified social relationships and institutional structures that may have a strong influence on antimicrobial use, which must be addressed concurrently. (i) Social relationships that exist across settings: these include the influence of personal risk, hierarchies, inter- and intraprofessional dynamics and sense of futility in making a difference long term in relation to antimicrobial resistance. (ii) Institutional structures that offer context-specific influences: these include patient population factors (including socioeconomic factors, geographical isolation and local infection patterns), proximity and resource issues.
The success of antimicrobial optimization rests on adequate awareness and incorporation of multilevel influences. Analysis of the problem has tended to emphasize individual 'behaviour improvement' in prescribing rather than incorporating the problem of overuse as inherently multidimensional and necessarily incorporating personal, interpersonal and institutional variables. A paradigm shift is urgently needed to incorporate these critical factors in antimicrobial optimization strategies.
尽管有大量关于抗生素耐药性的证据，并且人们知道优化抗生素使用将减缓耐药性的发展，但全球仍存在严重的抗生素过度使用现象。了解为什么会出现这种情况至关重要。本研究旨在通过深入的多地点分析，考虑澳大利亚医院内抗生素使用的社会影响。
我们使用了定性的多地点设计，包括 222 名个体的半结构化访谈和主题分析。参与者（85 名医生、79 名护士、31 名药剂师和 27 名医院管理人员）来自澳大利亚的五家医院，包括四家公立医院（两家大都市、一家地区医院和一家偏远医院）和一家私立医院。
对访谈的分析确定了可能对抗生素使用产生强烈影响的社会关系和机构结构，这些因素必须同时解决。（i）存在于各个环境中的社会关系：这些关系包括个人风险、等级制度、专业内外动态以及在长期对抗生素耐药性方面产生影响的徒劳感的影响。（ii）提供特定背景影响的机构结构：这些关系包括患者人群因素（包括社会经济因素、地理隔离和当地感染模式）、接近度和资源问题。
抗生素优化的成功取决于充分认识和整合多层次的影响。对该问题的分析往往强调处方方面的个体“行为改进”，而不是将过度使用问题视为固有多维的，并必然包含个人、人际和机构变量。迫切需要进行范式转变，将这些关键因素纳入抗生素优化策略中。
