Jinks Timothy, Subramaniam Sumithra, Bassetti Matteo, Gales Ana C, Kullar Ravina, Metersky Mark L, Poojary Aruna, Seifert Harald, Warrier Anup, Flayhart Diane, Kelly Timothy, Yu Kalvin, Altevogt Bruce M, Townsend Andy, Marsh Charlotte, Willis Clare
Wellcome Trust, Gibbs Building, 215 Euston Road, London, NW1 2BE, UK.
Infectious Diseases Unit, IRCCS San Martino Polyclinic Hospital and Department of Health Sciences (DISSAL), University of Genoa, Largo Benzi 10, 16132, Genoa, Italy.
Infect Dis Ther. 2024 Jul;13(7):1621-1637. doi: 10.1007/s40121-024-00996-1. Epub 2024 Jun 3.
Antimicrobial resistance (AMR) is a global public health challenge. Global efforts to decrease AMR through antimicrobial stewardship (AMS) initiatives include education and optimising the use of diagnostic technologies and antibiotics. Despite this, economic and societal challenges hinder AMS efforts. The objective of this study was to obtain insights from healthcare professionals (HCPs) on current challenges and identify opportunities for optimising diagnostic test utilisation and AMS efforts.
Three hundred HCPs from six countries (representing varied gross national incomes per capita, healthcare system structure, and AMR rates) were surveyed between November 2022 through January 2023. A targeted literature review and expert interviews were conducted to inform survey development. Descriptive statistics were used to summarise survey responses.
These findings suggest that the greatest challenges to diagnostic test utilisation were economic in nature; many HCPs reported that AMS initiatives were lacking investment (32.3%) and resourcing (40.3%). High resistance rates were considered the greatest barriers to appropriate antimicrobial use (52.0%). Most HCPs found local and national guidelines to be very useful (≥ 51.0%), but areas for improvement were noted. The importance of AMS initiatives was confirmed; diagnostic practices were acknowledged to have a positive impact on decreasing AMR (70.3%) and improving patient outcomes (81.0%).
AMS initiatives, including diagnostic technology utilisation, are pivotal to decreasing AMR rates. Interpretation of these survey results suggests that while HCPs consider diagnostic practices to be important in AMS efforts, several barriers to successful implementation still exist including patient/institutional costs, turnaround time of test results, resourcing, AMR burden, and education. While some barriers differ by country, these survey results highlight areas of opportunities in all countries for improved use of diagnostic technologies and broader AMS efforts, as perceived by HCPs. Greater investment, resourcing, education, and updated guidelines offer opportunities to further strengthen global AMS efforts.
抗菌药物耐药性（AMR）是一项全球性的公共卫生挑战。通过抗菌药物管理（AMS）举措来降低AMR的全球努力包括开展教育以及优化诊断技术和抗生素的使用。尽管如此，经济和社会挑战仍阻碍着AMS工作的开展。本研究的目的是了解医疗保健专业人员（HCP）对当前挑战的看法，并确定优化诊断测试利用和AMS工作的机会。
在2022年11月至2023年1月期间，对来自六个国家（代表不同人均国民收入、医疗系统结构和AMR率）的300名HCP进行了调查。开展了有针对性的文献综述和专家访谈，以为调查的制定提供参考。采用描述性统计方法对调查结果进行总结。
这些结果表明，诊断测试利用面临的最大挑战本质上是经济性的；许多HCP报告称，AMS举措缺乏投资（32.3%）和资源（40.3%）。高耐药率被认为是合理使用抗菌药物的最大障碍（52.0%）。大多数HCP认为地方和国家指南非常有用（≥51.0%），但也指出了有待改进的方面。AMS举措的重要性得到了证实；诊断实践被认为对降低AMR（70.3%）和改善患者预后（81.0%）有积极影响。
包括诊断技术利用在内的AMS举措对于降低AMR率至关重要。对这些调查结果的解读表明，虽然HCP认为诊断实践在AMS工作中很重要，但成功实施仍存在一些障碍，包括患者/机构成本、检测结果周转时间、资源、AMR负担和教育。虽然一些障碍因国家而异，但这些调查结果突出了所有国家在HCP看来改善诊断技术使用和更广泛的AMS工作的机会领域。加大投资、提供资源、开展教育以及更新指南为进一步加强全球AMS工作提供了机会。
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