Haque Mohibbul, Karim Mohammad Rezaul, Shohid Sabrin, Choudhury Shadman Sakib, Hossain Pilot, Sen Rotna Rani, Dey Chaity, Khan Sumaiya, Munni Meherun Nahar, Shopna Sonia Afroze, Shultana Razia, Al Fidah Md Fuad, Khan Md Abdullah Saeed, Farhana Nasreen
National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
National Institute of Preventive and Social Medicine, Dhaka, Bangladesh.
BMJ Open. 2024 Dec 22;14(12):e087201. doi: 10.1136/bmjopen-2024-087201.
Antimicrobial resistance (AMR) is a global health and development concern. Antimicrobial misuse and overuse are key contributors to the emergence of drug-resistant infections.
The current study aimed to determine the level of perception and practices of physicians regarding AMR in a tertiary-level hospital.
Cross-sectional study.
A tertiary care hospital in Dhaka, Bangladesh.
The study included 360 physicians who worked for more than 6 months in different departments of the hospital.
Perceptions of AMR among physicians and secondary outcome measures were to find out the practices of physicians regarding AMR. The current study used 8 defined responses and 6 multiple-choice questions for scoring physicians' perception of AMR and 12 items to score physicians' self-reported practice regarding AMR. After converting these scores into percentages, the median split method was used to categorise them into poor and good categories.
Among 360 physicians, 51% were male, the median (IQR) age was 30 (27.0-34.0) years and 46% had private practices. More than half (52%) had a poor perception of AMR but had good practice (57%) with no significant association between perception and practice. The perception of AMR was significantly associated with age (p=0.048), years in practice (p=0.011) and AMR training (p=0.030). Physicians with private practice had 1.71 times higher odds of having a good perception of AMR (95% CI 2.07 to 2.75, p=0.026) and 2.44 times higher odds of having good practice (95% CI 1.51 to 3.94, p<0.001). The odds of having a good perception of AMR increase 1.20 times with a 1-year increase in years of practice (95% CI 1.01 to 1.44, p=0.042).
The study revealed that most physicians had poor perception but good practice regarding AMR. Both poor perception and good practice were associated with private practice. To increase good practice and perception regarding AMR, efforts need to be made to establish an AMR education programme for practicing physicians as soon as possible. Moreover, medical audits and continuous quality improvement (such as programmes for antimicrobial stewardship) should be legislated, and monitoring prescribing behaviour and formulating policies accordingly are the way forward in combating AMR.
抗菌药物耐药性（AMR）是一个全球健康与发展问题。抗菌药物的不当使用和过度使用是耐药性感染出现的主要原因。
本研究旨在确定一家三级医院医生对抗菌药物耐药性的认知水平和实践情况。
横断面研究。
孟加拉国达卡的一家三级护理医院。
该研究纳入了360名在医院不同科室工作超过6个月的医生。
医生对抗菌药物耐药性的认知，次要结局指标是了解医生在抗菌药物耐药性方面的实践情况。本研究使用8个定义性回答和6个多项选择题来对抗菌药物耐药性认知进行评分，以及12个项目来对医生自我报告的抗菌药物耐药性实践进行评分。将这些分数转换为百分比后，采用中位数分割法将其分为差和良好两类。
在360名医生中，51%为男性，年龄中位数（四分位间距）为30（27.0 - 34.0）岁，46%有私人执业。超过一半（52%）的医生对抗菌药物耐药性认知较差，但实践良好（57%），认知与实践之间无显著关联。对抗菌药物耐药性的认知与年龄（p = 0.048）、执业年限（p = 0.011）和抗菌药物耐药性培训（p = 0.030）显著相关。有私人执业的医生对抗菌药物耐药性有良好认知的几率高1.71倍（95%置信区间2.07至2.75，p = 0.026），有良好实践的几率高2.44倍（95%置信区间1.51至3.94，p < 0.001）。随着执业年限每增加1年，对抗菌药物耐药性有良好认知的几率增加1.20倍（95%置信区间1.01至1.44，p = 0.042）。
该研究表明，大多数医生对抗菌药物耐药性认知较差，但实践良好。认知差和实践好均与私人执业有关。为了提高对抗菌药物耐药性的良好实践和认知，需要尽快为执业医生建立抗菌药物耐药性教育项目。此外，应制定医疗审计和持续质量改进（如抗菌药物管理项目）的法规，监测处方行为并据此制定政策是应对抗菌药物耐药性的前进方向。
