Intensivists’ perceptions and attitudes towards infectious diseases management in the ICU: An international survey / Percepciones y actitudes de los intensivistas hacia el manejo de enfermedades infecciosas en la UCI: una encuesta internacional

Objective Exploring infectious diseases (ID) practice in Intensive Care Unit (ICU) to identify gaps and opportunities. Design Online international survey (PRACT-INF-ICU) endorsed by the ESICM and open from July 30, 2019 to October 19, 2019. Setting International study conducted in 78 countries. Participants Physicians working in ICU. Interventions None. Main variables of interest Practice variations were assessed according to respondents’ countries income class, training, and years of practice. Univariate and multivariate ordinal logistic regression were used to estimate associations between respondents’ characteristics and their perceptions regarding adequacy of training. Results 466 intensivists with a median practice of 10 years (interquartile range, 5–19) completed the survey. A third reported no antimicrobial stewardship program and 40% had no regular microbiological rounds in their ICUs. Intensivists were mostly the decision makers for the initial antimicrobial therapy which in 70% of cases were based on guidelines or protocols. Non-ICU expertise were sought more frequently on reviewing (48/72h, culture adjustment and discontinuation in 32%, 39% and 21% respectively) rather than antimicrobial therapy initiation (16%). Only 42% described ID training as adequate. Multivariate ordinal logistic regression showed that low- to middle-income countries (OR: 0.41, 95% CI: 0.28–0.61), ICU practice ≤10 years (OR: 0.55, 95% CI: 0.39–0.79), and dual training with anaesthesia (OR: 0.52, 95% CI: 0.34–0.79) or medicine (OR: 0.49, 95% CI: 0.32–0.76) were associated with less training satisfaction. Conclusion ID practice is heterogeneous across ICUs while antimicrobial stewardship program is not universally implemented. From intensivists’ perspective, ID training and knowledge need improvement (AU)

Objetivo Explorar la práctica de enfermedades infecciosas (EI) en unidad de cuidados intensivos (UCI) para identificar lagunas y oportunidades. Diseño Encuesta internacional online. Ÿmbito Estudio internacional. Participantes Médicos que trabajan en UCI. Intervenciones Ninguna. Principales variables de interés Las variaciones de la práctica se evaluaron de acuerdo con la clase de ingresos de los países encuestados, la formación previa y los años de práctica. Se utilizaron análisis de regresión logística ordinal para estimar las asociaciones entre las características de los encuestados y sus percepciones con respecto a la adecuación de la capacitación. Resultados Cuatrocientos sesenta y seis intensivistas completaron la encuesta. Un tercio de los intensivistas informó que no tenía un programa de optimización de antimicrobianos y el 40% no tenía rondas microbiológicas regulares en su UCI. Los intensivistas eran mayoritariamente los iniciadores de la terapia antibiótica inicial que en el 70% de los casos estaba basada en guías clínicas y protocolos. La regresión logística ordinal multivariante mostró que los países de ingresos bajos a medianos (OR: 0,41; IC del 95%: 0,28-0,61), práctica en la UCI ≤10 años (OR: 0,55; IC del 95%: 0,39-0,79) y entrenamiento dual con anestesiología (OR: 0,52; IC del 95%:0,34–0,79) o medicina (OR: 0,49; IC del 95%: 0,32–0,76) se asociaron con una menor satisfacción con la capacitación en EI. Conclusiones La práctica en EI es heterogénea en todas las UCI, mientras que el programa de optimización de antimicrobianos no se implementa universalmente. Desde la perspectiva de los intensivistas, es necesario mejorar la formación y el conocimiento en EI (AU)

Intensivists' perceptions and attitudes towards infectious diseases management in the ICU: An international survey.

OBJECTIVE: Exploring infectious diseases (ID) practice in Intensive Care Unit (ICU) to identify gaps and opportunities. DESIGN: Online international survey (PRACT-INF-ICU) endorsed by the ESICM and open from July 30, 2019 to October 19, 2019. SETTING: International study conducted in 78 countries. PARTICIPANTS: Physicians working in ICU. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Practice variations were assessed according to respondents' countries income class, training, and years of practice. Univariate and multivariate ordinal logistic regression were used to estimate associations between respondents' characteristics and their perceptions regarding adequacy of training. RESULTS: 466 intensivists with a median practice of 10 years (interquartile range, 5-19) completed the survey. A third reported no antimicrobial stewardship program and 40% had no regular microbiological rounds in their ICUs. Intensivists were mostly the decision makers for the initial antimicrobial therapy which in 70% of cases were based on guidelines or protocols. Non-ICU expertise were sought more frequently on reviewing (48/72h, culture adjustment and discontinuation in 32%, 39% and 21% respectively) rather than antimicrobial therapy initiation (16%). Only 42% described ID training as adequate. Multivariate ordinal logistic regression showed that low- to middle-income countries (OR: 0.41, 95% CI: 0.28-0.61), ICU practice ≤10 years (OR: 0.55, 95% CI: 0.39-0.79), and dual training with anaesthesia (OR: 0.52, 95% CI: 0.34-0.79) or medicine (OR: 0.49, 95% CI: 0.32-0.76) were associated with less training satisfaction. CONCLUSION: ID practice is heterogeneous across ICUs while antimicrobial stewardship program is not universally implemented. From intensivists' perspective, ID training and knowledge need improvement.

Estado de los programas de optimización del uso de antimicrobianos en hospitales: resultados de una Encuesta Nacional 2022 en Perú

Introducción: Los programas de Optimización de Antimicrobianos (PROA) en Instituciones Sanitarias son una estrategia implementada en diversos países. El estudio: Nuestro objetivo fue realizar una encuesta electrónica en los establecimientos de salud que cuentan con servicios de hospitalización en el Perú. Hallazgos: Ciento setenta establecimientos (38.4%) respondieron la encuesta entre MINSA (90%), ESSALUD (4.2%), FFAA PNP (2.9%) y Privados (2.9%). Solo 49 (28.8%) contaba con PROA funcionando dentro de su institución. El 83.7% contaban con una Resolución directoral que respalda sus funciones y el 38.8% referían contar con un plan de actividades PROA. Los problemas más frecuentemente identificados son la falta de recursos humanos capacitados (24.6%), la falta de capacitación y asistencia técnica (13.1%) y la falla en la prescripción de antibióticos (11.5%). Conclusión: Es prioritario seguir fortaleciendo los PROA en hospitales en el corto plazo con actividades que estimulen el uso racional de antimicrobianos.

Background: The Antimicrobial Optimization Programs (PROA in Spanish) in Health Institutions are a strategy implemented in different countries. The study: Our objective was to carry out an electronic survey in health establishments that have hospitalization services in Peru. Findings: One hundred seventy establishments (38.4%) responded to the survey between MINSA (90%), ESSALUD (4.2%), Armed Forces PNP (2.9%) and Private (2.9%). Only 49 (28.8%) had PROA working within their institution. 83.7% had a Director Resolution that supported their functions and 38.8% reported having a PROA activity plan. The most frequent problems identified are the lack of trained human resources (24.6%), the lack of training and technical assistance (13.1%) and the failure to prescribe antibiotics (11.5%). Conclusion: It is a priority to continue strengthening the PROA in hospitals in the short term with activities that stimulate the rational use of antimicrobials.

Implementation of the delayed antibiotic prescribing strategy. Prospective observation study in primary care / Implementación de la estrategia de prescripción diferida de antibióticos. Estudio observacional prospectivo en atención primaria

Objectives. We aimed to compare the actual consumption of antibiotics among patients issued delayed antibioticprescribing with the consumption observed in a non-systematic review of studies on delayed prescribing.Methods. Observational study carried out in three primary care centres from September 2018 until March 2020. Wetracked the electronic records of the 82 patients with episodesof acute bronchitis and 44 acute pharyngitis who were givena patient-led delayed prescription to determine whether theprescription was filled and when this medication was obtained.Results. The prescriptions were never filled in 50 cases(39.7%), but five patients took another antibiotic within thefirst two weeks. Out of 76 patients who did take the delayedprescription, only 12 obtained the medication based on the instructions given by the doctors (15.8%).Conclusions. The strategy of delayed antibiotic prescribing resulted in a reduction in antibiotic use, but this reductionwas lower than in randomised clinical trials, being comparable to the results obtained with other observational studies ondelayed antibiotic prescribing. In addition, only a few patientsadhered to the doctors’ instructions (AU)

Objetivos. Evaluar el consumo de antibióticos entre lospacientes a los que se les efectuó una prescripción antibióticadiferida y compararlo con el consumo observado en una revisión no sistemática de estudios de prescripción diferida.Métodos. Estudio observacional en tres centros de saluddesde septiembre 2018 hasta marzo 2020. Se realizó un seguimiento de los registros electrónicos de los 82 pacientes conepisodios de bronquitis aguda y 44 faringitis aguda a los quese les entregó una prescripción diferida para evaluar si fue a lafarmacia a buscarla y cuándo la obtuvo.Resultados. No fueron a buscar la medicación en 50 casos (39,7%), pero cinco pacientes tomaron otro antibiótico enlas dos primeras semanas. De los 76 pacientes que recogieronla prescripción, solo 12 la obtuvieron según las instruccionesde sus médicos (15,8%).Conclusiones. La estrategia de prescripción diferida reduce el consumo de antibióticos, pero esta reducción es menorque la que se observa en ensayos clínicos, siendo comparablecon los resultados observados en otros estudios observacionales sobre prescripción diferida. Además, solo unos pocos pacientes siguieron las instrucciones de sus médicos. (AU)

Intensivists' perceptions and attitudes towards infectious diseases management in the ICU: An international survey.

OBJECTIVE: Exploring infectious diseases (ID) practice in Intensive Care Unit (ICU) to identify gaps and opportunities. DESIGN: Online international survey (PRACT-INF-ICU) endorsed by the ESICM and open from July 30, 2019 to October 19, 2019. SETTING: International study conducted in 78 countries. PARTICIPANTS: Physicians working in ICU. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Practice variations were assessed according to respondents' countries income class, training, and years of practice. Univariate and multivariate ordinal logistic regression were used to estimate associations between respondents' characteristics and their perceptions regarding adequacy of training. RESULTS: 466 intensivists with a median practice of 10 years (interquartile range, 5-19) completed the survey. A third reported no antimicrobial stewardship program and 40% had no regular microbiological rounds in their ICUs. Intensivists were mostly the decision makers for the initial antimicrobial therapy which in 70% of cases were based on guidelines or protocols. Non-ICU expertise were sought more frequently on reviewing (48/72h, culture adjustment and discontinuation in 32%, 39% and 21% respectively) rather than antimicrobial therapy initiation (16%). Only 42% described ID training as adequate. Multivariate ordinal logistic regression showed that low- to middle-income countries (OR: 0.41, 95% CI: 0.28-0.61), ICU practice ≤10 years (OR: 0.55, 95% CI: 0.39-0.79), and dual training with anaesthesia (OR: 0.52, 95% CI: 0.34-0.79) or medicine (OR: 0.49, 95% CI: 0.32-0.76) were associated with less training satisfaction. CONCLUSION: ID practice is heterogeneous across ICUs while antimicrobial stewardship program is not universally implemented. From intensivists' perspective, ID training and knowledge need improvement.