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Impact of the medical specialty on knowledge regarding multidrug-resistant organisms and strategies toward antimicrobial stewardship

  • Urology - Original Paper
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Abstract

Purpose

Evidence is scarce on subject-specific knowledge of multidrug-resistant organisms and rational use of antibiotics. We aimed at evaluating attitude, perception, and knowledge about multidrug-resistant organisms (MDRO) and antibiotic prescribing among urologists versus other medical specialties.

Methods

Within the MR2-study (Multiinstitutional Reconnaissance of practice with MultiResistant bacteria), a questionnaire was conducted targeting general surgeons, internists, gynecologists, and urologists in 18 German hospitals. The influence of medical specialty on predetermined endpoints was assessed by multivariable logistic regression models.

Results

With 456 evaluable questionnaires, the response rate was 43% (456/1061). Within seven workdays prior to survey, urologists prescribed antibiotics to >5 patients more often than non-urologists (50.7 vs. 24.3%; p < 0.001). Urologists were more confident regarding dosage, frequency, and duration of antibiotic treatment (p = 0.038) as well as in interpreting antibiograms (p < 0.001). Both urologists and non-urologists had poor knowledge about antibiotic stewardship. Urologists were more confident regarding local resistance patterns (p < 0.001). However, local rates of ciprofloxacin-resistant E. coli strains were correctly categorized by only 36.3 and 31.2% of urologists and non-urologists, respectively (p = 0.168). Compared to non-urologists, urologists more often acknowledged the use of broad-spectrum antibiotic agents as a problem, potentially resulting in increased resistance pattern (p = 0.036). Conversely, 31.5 and 30.7% of urologists and non-urologists (p = 0.424), respectively, would prescribe broad-spectrum antibiotics to a female patient with an uncomplicated urinary tract infection. Urologists did not attend more training courses regarding multidrug-resistance or antibiotic prescribing and did not perceive a better quality of discharge letters regarding MDRO.

Conclusions

There is substantial need for advanced training regarding MDRO and antibiotic stewardship, regardless of medical specialty.

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References

  1. European Centre for Disease Prevention and Control (2015) Antimicrobial resistance surveillance in Europe 2014. Annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). ECDC, Stockholm

  2. Pletz MW, Eckmann C, Hagel S, Heppner HJ, Huber K, Kammerer W et al (2015) Current strategies against multi-drug resistant organisms. Dtsch Med Wochenschr 140:975–981

    Article  PubMed  Google Scholar 

  3. Thern J, Kern WV (2015) Zur Diskussion: Qualitätsindikatoren Antibiotikaverschreibung und Infektionsmedizin. Z Evid Fortbild Qual Gesundhwes 109:511–514

    Article  PubMed  Google Scholar 

  4. DART 2020 (2016) Fighting antibiotic resistance for the good of both humans and animals. DART 2020 was elaborated by the Federal Ministry of Health, the Federal Ministry of Food and Agriculture as well as the Federal Ministry of Education and Research. http://www.bmg.bund.de/fileadmin/dateien/Publikationen/Ministerium/Broschueren/BMG_DART_2020_Bericht_en.pdf. Accessed 5 June 2016

  5. Davey P, Brown E, Charani E, Fenelon L, Gould IM, Holmes A et al (2013) Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev (4):CD003543. doi:10.1002/14651858.CD003543.pub3

  6. Gentile I, Landolfo D, Buonomo AR, Crispo M, Iula VD, Minei G et al (2015) A survey on antibiotic therapy knowledge among physicians of a tertiary care and university hospital. Infez Med 23:12–17

    PubMed  Google Scholar 

  7. Gonzalez-Gonzalez C, Lopez-Vazquez P, Vazquez-Lago JM, Pineiro-Lamas M, Herdeiro MT, Arzamendi PC et al (2015) Effect of physicians’ attitudes and knowledge on the quality of antibiotic prescription: a cohort study. PLoS ONE. doi:10.1371/journal.pone.0141820

    Google Scholar 

  8. Jump RL, Heath B, Crnich CJ, Moehring R, Schmader KE, Olds D et al (2015) Knowledge, beliefs, and confidence regarding infections and antimicrobial stewardship: a survey of Veterans Affairs providers who care for older adults. Am J Infect Control 43:298–300

    Article  PubMed  PubMed Central  Google Scholar 

  9. Navarro-San Francisco C, Del Toro MD, Cobo J, De Gea-Garcia JH, Vano-Galvan S, Moreno-Ramos F et al (2013) Knowledge and perceptions of junior and senior Spanish resident doctors about antibiotic use and resistance: results of a multicenter survey. Enferm Infecc Microbiol Clin 31:199–204

    Article  PubMed  Google Scholar 

  10. Pulcini C, Williams F, Molinari N, Davey P, Nathwani D (2011) Junior doctors’ knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland. Clin Microbiol Infect 17:80–87

    Article  CAS  PubMed  Google Scholar 

  11. Remesh A, Gayathri AM, Singh R, Retnavally KG (2013) The knowledge, attitude and the perception of prescribers on the rational use of antibiotics and the need for an antibiotic policy—a cross sectional survey in a tertiary care hospital. J Clin Diagn Res. 7:675–679

    PubMed  PubMed Central  Google Scholar 

  12. Hansen S, Sohr D, Piening B, Pena Diaz L, Gropmann A, Leistner R et al (2013) Antibiotic usage in German hospitals: results of the second national prevalence study. J Antimicrob Chemother 68:2934–2939

    Article  CAS  PubMed  Google Scholar 

  13. Cek M, Tandogdu Z, Wagenlehner F, Tenke P, Naber K, Bjerklund-Johansen TE (2014) Healthcare-associated urinary tract infections in hospitalized urological patients—a global perspective: results from the GPIU studies 2003–2010. World J Urol 32:1587–1594

    Article  PubMed  Google Scholar 

  14. Tandogdu Z, Bartoletti R, Cai T, Cek M, Grabe M, Kulchavenya E et al (2015) Antimicrobial resistance in urosepsis: outcomes from the multinational, multicenter global prevalence of infections in urology (GPIU) study 2003–2013. World J Urol 34:1193–1200

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lebentrau S, Vetterlein MW, May M (2016) The urologist’s role in antibiotic stewardship: results from the MR2 study. Eur Urol. doi:10.1016/j.eururo.2016.12.011

    Google Scholar 

  16. Grabe M, Bartoletti R, Bjerklund Johansen TE, Cai T, Cek M, Köves B et al (2015) EAU-guidelines on urological infections. Limited Update. European Association of Urology, Arnhem, The Netherlands

  17. McCaig LF, Besser RE, Hughes JM (2003) Antimicrobial drug prescription in ambulatory care settings, United States, 1992–2000. Emerg Infect Dis 9:432–437

    Article  PubMed  PubMed Central  Google Scholar 

  18. Augustin J, Mangiapane S, Kern W (2016) Antibiotikaverordnungen im Jahr 2010 im regionalen Vergleich. http://www.versorgungsatlas.de/fileadmin/ziva_docs/Antibiotika_Bericht_final.pdf. Accessed 5 June 2016

  19. Cai T, Verze P, Brugnolli A, Tiscione D, Luciani LG, Eccher C et al (2016) Adherence to European association of urology guidelines on prophylactic antibiotics: an important step in antimicrobial stewardship. Eur Urol 69:276–283

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank our colleagues from the following hospitals for participating in the MR2 study: Barmherzige Brüder Hospitals Munich, Regensburg and Straubing, Biberach Hospital, Carl-Thiem Klinikum Cottbus, Clinic Dortmund, Frankfurt/Oder Hospital, Garmisch-Partenkirchen Hospital, University Clinic Gießen, Hameln Hospital, University Medical Center Magdeburg, University Medical Center of the Technical University Munich, Nauen Hospital, Ruppiner Kliniken and Brandenburg Medical School, Pegnitz Hospital, Caritas St. Josef Medical Center Regensburg, Kliniken Nordoberpfalz, Weiden.

MR2 study group collaborators

Sabine Beiser, Jörg Bernhardt, Thomas Bschleipfer, Özden Dirik, Johannes Geiss, Katharina Hauner, Bernd Hoschke, Thomas Karl, Andreas Kestler, Theodor Klotz, Christian Kuhl, Mike Lehsnau, Arno Macht, Giuseppe Magistro, Odilo Maurer, Alexander Novotny, Ulrike Necknig, Robert Obermaier, Soeren Promnitz, Margitta Retz, Christoph Scheu, Carsten Scholz, Christian G. Stief, Michael Truß.

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Authors and Affiliations

  1. Department of Urology and Pediatric Urology, Brandenburg Medical School, Ruppiner Kliniken, Fehrbelliner Straße 38, 16816, Neuruppin, Germany

    Steffen Lebentrau

  2. Department of Urology, St. Elisabeth Hospital, St.-Elisabeth-Str. 23, 94315, Straubing, Germany

    Christian Gilfrich, Harald Schumacher & Matthias May

  3. Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Malte W. Vetterlein

  4. Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany

    Philipp J. Spachmann, Hans M. Fritsche & Maximilian Burger

  5. Department of Urology, LMU Munich, Großhadern, Marchioninistraße 15, 81377, Munich, Germany

    Sabine D. Brookman-May

  6. Department of Urology and Pediatric Urology, Magdeburg University Medical Center, Otto-von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany

    Martin Schostak

  7. Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany

    Florian M. Wagenlehner

Authors
  1. Steffen Lebentrau
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  2. Christian Gilfrich
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  3. Malte W. Vetterlein
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  4. Harald Schumacher
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  6. Sabine D. Brookman-May
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  7. Hans M. Fritsche
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  8. Martin Schostak
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  9. Florian M. Wagenlehner
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  10. Maximilian Burger
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  11. Matthias May
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Consortia

MR2 study group

  • Sabine Beiser
  • , Jörg Bernhardt
  • , Thomas Bschleipfer
  • , Özden Dirik
  • , Johannes Geiss
  • , Katharina Hauner
  • , Bernd Hoschke
  • , Thomas Karl
  • , Andreas Kestler
  • , Theodor Klotz
  • , Christian Kuhl
  • , Mike Lehsnau
  • , Arno Macht
  • , Giuseppe Magistro
  • , Odilo Maurer
  • , Alexander Novotny
  • , Ulrike Necknig
  • , Robert Obermaier
  • , Soeren Promnitz
  • , Margitta Retz
  • , Christoph Scheu
  • , Carsten Scholz
  • , Christian G. Stief
  •  & Michael Truß

Corresponding author

Correspondence to Steffen Lebentrau.

Ethics declarations

Conflict of interest

F. Wagenlehner has served as a paid consultant for Achaogen, Astellas, AstraZeneca, Bionorica, Cubist, Galenus, GSK, Janssen, Leo-Pharma, Merlion, MSD, OM-Pharma, Pierre Fabre, Rosen Pharma, and Zambon, has received payment for presenting at continuing medical education events from Astellas, AstraZeneca, Bionorica Cubist, Galenus, Leo-Pharma, Merlion, MSD, OM-Pharma, Pierre Fabre, Rosen Pharma, and Zambon, has also received payment for carrying out clinical trials on behalf of Achaogen, Astellas, AstraZeneca, Bionorica, Calixa, Cerexa, Cubist, The German Research Foundation (Deutsche Forschungsgemeinschaft), the European Association of Urology, Galenus, The Hessen State Ministry of Higher Education, Research and the Arts, Merlion, OM-Pharma, Rosen Pharma, and Zambon. S. Brookman-May is an employee of Janssen Pharma Research and Development (Director Clinical Research Oncology) at time of study design, conduct, and analysis. The other authors have no conflicts to report.

Ethical standard

We affirm that all authors have complied with the principles of International Urology and Nephrology regarding ethical responsibilities of authors and compliance with ethical standards.

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Lebentrau, S., Gilfrich, C., Vetterlein, M.W. et al. Impact of the medical specialty on knowledge regarding multidrug-resistant organisms and strategies toward antimicrobial stewardship. Int Urol Nephrol 49, 1311–1318 (2017). https://doi.org/10.1007/s11255-017-1603-1

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  • DOI: https://doi.org/10.1007/s11255-017-1603-1

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