Assessing the Need for Antimicrobial Use Guidelines among Staff at King Abdulaziz Medical City, Kingdom of Saudi Arabia, 2013 Öffentlichkeit

Abstract

Introduction:

Recent studies show antimicrobial resistance to be an emerging problem in the medical community. Evidence-based guidelines can improve antibiotic usage, but are difficult to construct and implement. Prioritization of current knowledge and practice habits can enhance efficient message delivery. To better understand which guidelines should be prioritized, we surveyed knowledge, attitudes, and practices (KAP) among the medical staff at King Abdulaziz Medical City (KAMC), Riyadh, Kingdom of Saudi Arabia (KSA).

Methods:

Between Jan 1 - Mar 1, 2013, a convenience sample of 759 physicians and medical residents at KAMC was contacted via email and they were requested to complete a 20-minute, web-based survey that included five vignettes for three practice settings (primary care, intensive care, and medical residents).

Results:

Among 134 (49%) of 285 primary care physicians who responded, > 90% correctly answered vignette one (oral amoxicillin for uncomplicated Group A streptococcal pharyngitis) and vignette two (oral TMP-SMX for seven days for uncomplicated E. coli UTI). More than 70% of participants correctly answered vignette three (oral moxifloxicin for uncomplicated acute maxillary sinusitis) and vignette four (oral ciprofloxacin for complicated S. pneumoniae in a smoker). Approximately 50% correctly identified TMP-SMX as a better choice than ampicillin for acute bacterial prostatitis (vignette five). Correct answers on vignettes were not associated with age group, gender, or training status (resident or not). No significant associations (p <0.05) were found between attitudes and performance on the vignettes.

Discussion:

Based on the vignette scores, guideline creation and dissemination can be prioritized. Vignettes one and two showed good awareness and correct action so inclusion within the guidelines may not be necessary. The most urgent gap in knowledge was for drug use in acute bacterial prostatitis (vignette five). Future studies should focus on methods to improve participation, to evaluate the value of vignettes as a guide to prioritization, and the knowledge and attitudes portions of the survey.

Table of Contents

Table of Contents

Chapter 1 ...................................................................1

Contribution of the student ...................................................................1

Literature Review ...................................................................1

KAP Questionnaire Research ...................................................................1

Vignette-Based KAP Questionnaires ...................................................................7

Conclusion ...................................................................10

Justification ...................................................................10

Chapter 2 ...................................................................12

Manuscript ...................................................................12

Abstract ...................................................................12

Introduction ...................................................................14

Methods ...................................................................16

Survey Tool ...................................................................16

Survey Dissemination ...................................................................16

Statistical Analyses ...................................................................17

Results ...................................................................17

Table 1 ...................................................................18

Table 2 ...................................................................19

Figure 1 ...................................................................20

Discussion ...................................................................21

References ...................................................................23

Appendices ...................................................................25

Table 1 ...................................................................25

Table 2 ...................................................................25

Figure 1 ...................................................................27

Chapter 3...................................................................28
Conclusions and Recommendations ...................................................................28

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Stichwort	Vignette Antimicrobial Resistance Knowledge Stewardship
Committee Chair / Thesis Advisor	Klugman, Keith P, Emory University
Committee Members	McNabb, Scott JN, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti)

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