影响牙医使用抗生素预防措施的因素：来自国家基于牙科实践的研究网络调查问卷的结果。
Factors that affect dentists' use of antibiotic prophylaxis: Findings from The National Dental Practice-Based Research Network questionnaire.
作者信息
Lockhart Peter B, Thornhill Martin H, Zhao Jing, Baddour Larry M, Gilbert Gregg H, McKnight Patrick E, Stephens Casey, Mougeot Jean-Luc
出版信息
J Am Dent Assoc. 2022 Jun;153(6):552-562. doi: 10.1016/j.adaj.2021.11.010. Epub 2022 Mar 5.
BACKGROUND
Little is known about factors that influence dentists' decision making concerning antibiotic prophylaxis (AP) prescribing. The objective of this study was to determine factors that influence dentists' AP prescribing habits in patients at risk of developing infective endocarditis and prosthetic joint infections.
METHODS
A questionnaire was administered to 3,584 dentist members of The National Dental Practice-Based Research Network. In addition to descriptive statistics, ordinal regression models were used to determine the factors most likely to impact dentists' decisions to prescribe AP.
RESULTS
Overall, 2,169 (61%) dentists in The National Dental Practice-Based Resesarch Network responded. Responders' decisions to prescribe antibiotics were influenced primarily by official guidelines, scientific literature, and physician or medical specialist opinion. Regarding potential risks, the greatest level of concern was for the development of infective endocarditis or prosthetic joint infections. Although litigation was deemed problematic, more than 90% of responders indicated a strong concern for the best course of action for the patient's health. Dentists also indicated a high level of concern about the potential for generating antibiotic-resistant bacteria with AP use and increased risk of adverse drug reactions.
CONCLUSIONS
Dentists' AP decision making seems most influenced by official guidelines, scientific literature, and advice from a physician or medical specialist.
PRACTICAL IMPLICATIONS
These results suggest that one of the most effective means for promoting concordance of dentists clinical practice with the scientific basis for AP is to emphasize the importance and clarity of American Heart Association and American Dental Association recommendations and antimicrobial stewardship regarding prevention of infective endocarditis and prosthetic joint infections.
背景
关于影响牙医开具抗生素预防（AP）处方决策的因素，人们了解甚少。本研究的目的是确定影响牙医对有感染性心内膜炎和人工关节感染风险患者开具AP处方习惯的因素。
方法
对国家基于牙科实践的研究网络的3584名牙医成员进行了问卷调查。除描述性统计外，还使用有序回归模型来确定最有可能影响牙医开具AP处方决策的因素。
结果
总体而言，国家基于牙科实践的研究网络中有2169名（61%）牙医做出了回应。回应者开具抗生素的决策主要受官方指南、科学文献以及医生或医学专家意见的影响。关于潜在风险，最令人担忧的是感染性心内膜炎或人工关节感染的发生。尽管诉讼被认为是个问题，但超过90%的回应者表示非常关注患者健康的最佳行动方案。牙医们还表示高度关注使用AP产生抗生素耐药菌的可能性以及药物不良反应风险的增加。
结论
牙医的AP决策似乎最受官方指南、科学文献以及医生或医学专家建议的影响。
实际意义
这些结果表明，促进牙医临床实践与AP科学依据一致性的最有效方法之一，是强调美国心脏协会和美国牙科协会关于预防感染性心内膜炎和人工关节感染的建议以及抗菌药物管理的重要性和清晰度。
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