Clinicians' Knowledge, Attitudes, and Practices regarding Infections with Multidrug-Resistant Gram-Negative Bacilli in Intensive Care Units

Abstract

Objective-To assess how healthcare professionals caring for patients in intensive care units (ICUs) understand and use antimicrobial susceptibility testing (AST) for multidrug-resistant gramnegative bacilli (MDR-GNB).Design-A knowledge, attitude and practice survey assessed ICU clinicians knowledge of antimicrobial resistance, confidence interpreting susceptibility testing, and beliefs regarding the impact of susceptibility testing on patient outcomes. Setting-16ICUs affiliated with New York-Presbyterian Hospital.Participants-Attending physicians and subspecialty residents with primary clinical responsibilities in adult or pediatric ICUs and infectious diseases (ID) subspecialists and clinical pharmacists. Methods-Participants completed an anonymous electronic survey. Responses included 4-levelLikert scales dichotomized for analysis. Multivariate analyses were performed using Generalized Estimating Equations logistic regression to account for correlation of respondents from the same ICU. Potential conflict of interest:All authors report no conflicts of interest relevant to this article. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptResults-The response rate was 51% (178/349 eligible participants) of whom 120 (67%) were ICU physicians. Those caring for adult patients were more knowledgeable about antimicrobial activity and more familiar with MDR-GNB infections. Only 33% and 12% of ICU physicians were familiar with standardized and specialized AST methods, respectively, but >95% believed AST improved patient outcomes. When adjusted for demographic and healthcare provider characteristics, those familiar with treatment of MDR-GNB bloodstream infections, those aware of resistance mechanisms, and those aware of AST methods were more confident they could interpret AST and/or request additional in vitro testing.Conclusions-Our study uncovered knowledge gaps and educational needs that could serve as the foundation for future interventions. Familiarity with MDR-GNB increased overall knowledge and familiarity with AST increased confidence interpreting these results.

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