背景:由于不合理的抗生素使用和缺乏有效的抗菌药物管理计划(ASP),抗菌药物耐药性(AMR)的增长使常见感染危及生命。
目的:为了调查意识,医生对ASP的看法和做法,孟加拉国三级保健医院的AMR和抗生素处方。
方法:这项基于医院的横断面调查于2020年9月至2021年1月在孟加拉国的11家三级医院进行。通过面对面访谈进行半结构化问卷进行数据收集。使用STATA版本13进行描述性和多变量分析。
结果:总计,559名医生参加了这项调查。总的来说,40.6%[95%置信区间(CI)36.5-44.8]的医生报告知道ASP,与私立医院相比,公立医院的这一数字更高(43.8%对27.1%)。所有研究医院都没有任何ASP计划。超过一半(55.1%)的参与者愿意接受ASP对抗生素选择的反馈。只有30.9%的受访者表示,他们在开抗生素之前等待微生物测试的结果,尽管挑战包括经验性使用广谱抗生素,延迟的实验室结果和耐药患者的存在。相比之下,了解ASP的医师有33%(调整后比值比0.67,95%CI0.45-0.98;P=0.033)的患者在开抗生素前等待实验室检查结果的可能性较小.然而,42.5%的医生在处方时认为患者购买抗生素的承受能力。
结论:发现医师对ASP的基本知识和合理的抗生素处方达不到标准。特定上下文和集成的ASP活动,指南的可用性和使用,在孟加拉国,需要改进的实验室设施来对抗AMR。
BACKGROUND: The concerning growth of antimicrobial resistance (AMR) renders common infections life-threatening due to irrational antibiotic use and a lack of effective antimicrobial stewardship programmes (ASPs).
OBJECTIVE: To investigate the awareness, perceptions and practices of physicians regarding ASPs, AMR and antibiotic prescribing in tertiary care hospitals in Bangladesh.
METHODS: This hospital-based cross-sectional survey was conducted in 11 tertiary care hospitals across Bangladesh between September 2020 and January 2021. A semi-structured questionnaire was administered through face-to-face interviews for data collection. Descriptive and multi-variate analyses were performed using STATA Version 13.
RESULTS: In total, 559 physicians were enrolled in this survey. Overall, 40.6% [95% confidence interval (CI) 36.5-44.8] of physicians reported being aware of ASPs, and this figure was higher in public hospitals compared with private hospitals (43.8% vs 27.1%). None of the study hospitals had any
ASP initiatives. More than half (55.1%) of the participants were willing to receive feedback from an
ASP on their antibiotic selection. Only 30.9% of respondents stated that they wait for the findings of microbiological tests before prescribing antibiotics, although challenges included empiric use of broad-spectrum antibiotics, delayed laboratory results and the existence of drug-resistant patients. In contrast, physicians aware of ASPs were 33% (adjusted odds ratio 0.67, 95% CI 0.45-0.98; P=0.033) less likely to wait for laboratory results before prescribing antibiotics. However, 42.5% of physicians considered patient affordability of purchasing antibiotics when prescribing.
CONCLUSIONS: Physicians\' fundamental knowledge of ASPs and rational antibiotic prescription were found to fall short of the standard. Context-specific and integrated
ASP activities, availability and use of guidelines, and improved laboratory facilities are required to battle AMR in Bangladesh.