Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.
Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
BMJ Open. 2022 May 19;12(5):e054768. doi: 10.1136/bmjopen-2021-054768.
Antibiotic overuse is one of the main drivers of antimicrobial resistance (AMR), especially in low-income and middle-income countries. This study aimed to understand the perceptions and views towards AMR, antibiotic prescribing practice and antimicrobial stewardship (AMS) among hospital physicians in Jakarta, Indonesia.
Cross-sectional, self-administered questionnaire-based survey, with descriptive statistics, exploratory factor analysis (EFA) to identify distinct underlying constructs in the dataset, and multivariable linear regression of factor scores to analyse physician subgroups.
Six public and private acute-care hospitals in Jakarta in 2019.
1007 of 1896 (53.1% response rate) antibiotic prescribing physicians.
Physicians acknowledged the significance of AMR and contributing factors, rational antibiotic prescribing, and purpose and usefulness of AMS. However, this conflicted with reported suboptimal local hospital practices, such as room cleaning, hand hygiene and staff education, and views regarding antibiotic decision making. These included insufficiently applying AMS principles and utilising microbiology, lack of confidence in prescribing decisions and defensive prescribing due to pervasive diagnostic uncertainty, fear of patient deterioration or because patients insisted. EFA identified six latent factors (overall Crohnbach's α=0.85): awareness of AMS activities; awareness of AMS purpose; views regarding rational antibiotic prescribing; confidence in antibiotic prescribing decisions; perception of AMR as a significant problem; and immediate actions to contain AMR. Factor scores differed across hospitals, departments, work experience and medical hierarchy.
AMS implementation in Indonesian hospitals is challenged by institutional, contextual and diagnostic vulnerabilities, resulting in externalising AMR instead of recognising it as a local problem. Appropriate recognition of the contextual determinants of antibiotic prescribing decision making will be critical to change physicians' attitudes and develop context-specific AMS interventions.
抗生素的过度使用是导致抗微生物药物耐药性（AMR）的主要因素之一，尤其是在低收入和中等收入国家。本研究旨在了解印度尼西亚雅加达医院医生对抗微生物药物耐药性的看法、抗生素处方实践和抗菌药物管理（AMS）。
横断面、自我管理问卷的调查，采用描述性统计、探索性因子分析（EFA）来确定数据集中的不同潜在结构，以及因子得分的多变量线性回归来分析医生亚组。
2019 年雅加达的六家公立和私立急性护理医院。
1896 名抗生素处方医生中的 1007 名（53.1%的回复率）。
医生承认 AMR 的重要性及其相关因素、合理的抗生素处方以及 AMS 的目的和有用性。然而，这与当地医院的一些不尽人意的实践相冲突，如房间清洁、手卫生和员工教育，以及对抗生素决策的看法。这些包括未能充分应用 AMS 原则和利用微生物学，对抗生素处方决策缺乏信心，由于普遍存在的诊断不确定性而采取防御性处方，担心患者病情恶化或因为患者坚持。EFA 确定了六个潜在因素（总体 Cronbach's α=0.85）：对 AMS 活动的认识；对 AMS 目的的认识；对抗生素合理处方的看法；对抗生素处方决策的信心；对 AMR 作为一个重大问题的看法；以及立即采取行动遏制 AMR。因子得分在医院、科室、工作经验和医疗层级之间存在差异。
印度尼西亚医院的 AMS 实施面临着制度、背景和诊断方面的脆弱性的挑战，导致将 AMR 外化而不是将其视为当地的问题。适当认识到抗生素处方决策的背景决定因素对于改变医生的态度和制定针对具体情况的 AMS 干预措施至关重要。
