Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri.
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Missouri.
Infect Control Hosp Epidemiol. 2022 Oct;43(10):1368-1374. doi: 10.1017/ice.2021.389. Epub 2022 Aug 12.
To evaluate the attitudes of infectious diseases (ID) and critical care physicians toward antimicrobial stewardship in the intensive care unit (ICU).
Anonymous, cross-sectional, web-based surveys.
Surveys were completed in March-November 2017, and data were analyzed from December 2017 to December 2019.
ID and critical care fellows and attending physicians.
We included 10 demographic and 17 newly developed, 5-point, Likert-scaled items measuring attitudes toward ICU antimicrobial stewardship and transdisciplinary collaboration. Exploratory principal components analysis (PCA) was used for data reduction. Multivariable linear regression models explored demographic and attitudinal variables.
Of 372 respondents, 315 physicians had complete data (72% attendings, 28% fellows; 63% ID specialists, and 37% critical care specialists). Our PCA yielded a 3-item factor measuring which specialty should assume ICU antimicrobial stewardship (Cronbach standardized α = 0.71; higher scores indicate that ID physicians should be stewards), and a 4-item factor measuring value of ICU transdisciplinary collaborations (α = 0.62; higher scores indicate higher value). In regression models, ID physicians (vs critical care physicians), placed higher value on ICU collaborations and expressed discomfort with uncertain diagnoses. These factors were independently associated with stronger agreement that ID physicians should be ICU antimicrobial stewards. The following factors were independently associated with higher value of transdisciplinary collaboration: female sex, less discomfort with uncertain diagnoses, and stronger agreement with ID physicians as ICU antimicrobial stewards.
ID and critical care physicians endorsed their own group for antimicrobial stewardship, but both groups placed high value on ICU transdisciplinary collaborations. Physicians who were more uncomfortable with uncertain diagnoses reported preference for ID physicians to coordinate ICU antimicrobial stewardship; however, physicians who were less uncomfortable with uncertain diagnoses placed greater value on ICU collaborations.
评估传染病（ID）和重症监护医师对重症监护病房（ICU）抗菌药物管理的态度。
匿名、横断面、基于网络的调查。
调查于 2017 年 3 月至 11 月完成，数据于 2017 年 12 月至 2019 年 12 月进行分析。
ID 和重症监护住院医师和主治医生。
我们纳入了 10 项人口统计学和 17 项新开发的 5 分李克特量表项目，用于衡量对 ICU 抗菌药物管理和跨学科合作的态度。采用探索性主成分分析（PCA）进行数据降维。多变量线性回归模型探讨了人口统计学和态度变量。
在 372 名受访者中，有 315 名医生有完整的数据（72%的主治医生，28%的住院医生；63%的传染病专家和 37%的重症监护专家）。我们的 PCA 产生了一个 3 项因子，用于衡量哪个专业应该承担 ICU 抗菌药物管理的责任（Cronbach 标准化α=0.71；得分越高表示 ID 医生应该是管理者），以及一个 4 项因子，用于衡量 ICU 跨学科合作的价值（α=0.62；得分越高表示价值越高）。在回归模型中，ID 医生（与重症监护医生相比），对 ICU 合作的重视程度更高，对不确定诊断的不适感也更强。这些因素与更强的共识独立相关，即 ID 医生应该是 ICU 抗菌药物管理的管理者。以下因素与跨学科合作的价值高度相关：女性、对不确定诊断的不适感较弱、对 ID 医生作为 ICU 抗菌药物管理者的认同度较高。
ID 和重症监护医师均支持自己的专业组进行抗菌药物管理，但两组均高度重视 ICU 跨学科合作。对不确定诊断的不适感更强的医生更倾向于 ID 医生来协调 ICU 抗菌药物管理；然而，对不确定诊断的不适感较弱的医生则更看重 ICU 合作。
