Relating knowledge, attitude and practice of antibiotic use to extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage: results of a cross-sectional community survey

Mo, Yin; Seah, Ivan; Lye, Pei Shi Priscillia; Kee, Xiang Lee Jamie; Wong, Kien Yee Michael; Ko, Kwan Ki Karrie; Ong, Rick Twee‐Hee; Tambyah, Paul Ananth; Cook, Alex R.

doi:10.1136/bmjopen-2018-023859

Cited by 21 publications

(22 citation statements)

References 34 publications

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“…Several studies have revealed that antibiotics are more likely to be prescribed under patients' pressure [25]. Another study revealed widespread misconceptions about the utility of antibiotics for viral infections [26]. This is consistent with the findings of a global survey conducted by the world health organization (WHO) in 2015 [27].…”

Section: Discussionsupporting

confidence: 78%

Antibiotic use and resistance: an unprecedented assessment of university students’ knowledge, attitude and practices (KAP) in Lebanon

et al. 2020

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Background: The emergence and spread of pathogenic bacteria that is resistant to antibiotics has become a major public health concern. The incorrect prescription, inappropriate consumption and excess use of antimicrobial drugs, specifically antibiotics, are possibly the main factors contributing to the widespread of antibiotic resistant bacteria. This study aims to evaluate the knowledge, attitude and practices (KAP) towards the use of antibiotics as well as their resistance among Lebanese university students in health and non-health related majors. Methods: This cross-sectional study was conducted between May and June 2019 in Beirut (Lebanon) in which 750 students completed a questionnaire made up of four dimensions: Socio-demographic characteristics, 3 questions; assessment of knowledge, attitude and practices, 7, 10 and 1 question, respectively. The data was collected in spreadsheets and analysed with descriptive statistics. The difference in mean scores in each of the knowledge, attitude and practices dimensions between health and non-health related major students was analysed using tstudent tests and the difference in percentages using chi-square tests. Results: Almost 78% of respondents from the health related majors scored high knowledge compared to only 41% of non-health related majors (mean = 4.26; standard error = 0.05 versus mean = 3.41; standard error = 0.13, respectively). The attitude score of the health related major students (35.42%) was positive and more satisfactory compared to the non-health related students (7.32%); (mean = 9.34; standard error = 0.05 versus mean = 9.10; standard error = 0.21, respectively). However, the difference in the scores of attitudes was not statistically significant. Conclusions: Interventions to promote awareness in this area should focus more students in on non-health related majors.

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Section: Discussionsupporting

confidence: 78%

Antibiotic use and resistance: an unprecedented assessment of university students’ knowledge, attitude and practices (KAP) in Lebanon

et al. 2020

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“…These differences could have affected the pooled OR estimates. Particularly, we should note that the chronic diseases three studies investigated were different among studies, and there was a high variation in disease incidence within the studies [37,45,50]. Furthermore, there were three studies reporting association for PPI use as risk factors for fecal carriage of drug-resistant E. coli [46,50,51], and McNulty et al…”

Section: Discussionmentioning

confidence: 98%

“…Of these, 58 studies were forwarded to full-text article screening. Of the 58 full-text articles, we identified 15 relevant articles that reported risk factors associated with drug-resistant Enterobacteriaceae (10) or E. coli (5) carriage [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”

Section: Study Selectionmentioning

confidence: 99%

Risk factors for fecal carriage of drug-resistant Escherichia coli: a systematic review and meta-analysis

Matsui

Riley

2020

Antimicrob Resist Infect Control

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Background: Antimicrobial resistance is a serious public health problem. Fecal carriage of drug-resistant bacteria has been suggested as an important source of antimicrobial resistant genes (ARGs). We aimed to identify risk factors associated with fecal carriage of drug-resistant commensal Escherichia coli among healthy adult population. Methods: We conducted a systematic review and meta-analysis following the PRISMA guideline. We identified observational studies published from 2014 to 2019 through PubMed, Embase, and Web of Science. Studies were eligible if they investigated and reported risk factors and accompanying measure of associations for fecal carriage of drug-resistant E. coli for healthy population aged 18-65. Data on risk factors assessed in three or more studies were extracted. Results: Fifteen of 395 studies involving 11480 healthy individuals were included. The pooled prevalence of drug-resistant Enterobacteriaceae was 14% (95% confidence interval [CI] 8-23%). Antimicrobial use within the 12 months prior to stool culture (odds ratio [OR] 1.84 [95%CI 1.35-2.51]), diarrhea symptoms (OR 1.56 [95%CI 1.09-2.25]), travel to India (OR 4.15 [95%CI 2.54-6.78]), and vegetarian diet (OR 1.60 [95%CI 1.00(1.0043)-2.56(2.5587)]) were associated with increased risk of fecal carriage of drug-resistant E. coli. Among travellers, antimicrobial use (OR 2.81 [95%CI 1.47-5.36]), diarrhea symptoms (OR 1.65 [95%CI 1.02-2.68]), travel to India (OR 3.80 [95%CI 2.23-6.47]), and vegetarian diet (OR 1.92 [95%CI 1.13-3.26]) were associated with increased risk. Among general adult population, antimicrobial use (OR 1.51 [95%CI 1.17-1.94]), diarrhea symptoms (OR 1.53 [95%CI 1.27-1.84]), and travel to Southeast Asia (OR 1.67 [95%CI 1.02-2.73]) were associated with the increased risk of drug-resistant E. coli carriage. Conclusions:The findings indicate that dietary habit as well as past antimicrobial use and travel to high-risk country are associated with the risk of fecal carriage of drug-resistant commensal E. coli.

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“…The knowledge levels among this study population are comparable to those found by Mo et al in Singapore. Their study found that 43.8% of their population believed antibiotics were for viral infections [ 15 ], while 37.8% of this study population believed antibiotics can kill viruses. However, the effect of knowledge on ESBL-EC carriage differed between both studies.…”

Section: Discussionmentioning

confidence: 99%

“…While these studies identify avenues for intervention, they do not directly link KAP to the laboratory-confirmed presence or absence of drug-resistant bacteria. To the authors’ knowledge, only three studies to date have analyzed the link of KAP to laboratory-confirmed outcomes: (1) KAP and presence of antibiotic resistant, diarrheagenic E. coli [ 13 ]; (2) KAP of pig farmers and AMR carriage in their pigs [ 14 ], and (3) knowledge of proper antibiotic use in Singaporeans and AMR carriage among that population [ 15 ]. The present study builds on these previous studies and aims to assess how KAP of proper use of antibiotic agents is associated with laboratory-confirmed carriage of antibiotic resistant bacteria.…”

Section: Introductionmentioning

confidence: 99%

Caretaker knowledge, attitudes, and practices (KAP) and carriage of extended-spectrum beta-lactamase-producing E. coli (ESBL-EC) in children in Quito, Ecuador

Marusinec

Kurowski

Amato

et al. 2021

Antimicrob Resist Infect Control

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Background The rapid spread of extended-spectrum beta-lactamase-producing E. coli (ESBL-EC) is an urgent global health threat. We examined child caretaker knowledge, attitudes, and practices (KAP) towards proper antimicrobial agent use and whether certain KAP were associated with ESBL-EC colonization of their children. Methods Child caretakers living in semi-rural neighborhoods in peri-urban Quito, Ecuador were visited and surveyed about their KAP towards antibiotics. Fecal samples from one child (less than 5 years of age) per household were collected at two time points between July 2018 and May 2019 and screened for ESBL-EC. A repeated measures analysis with logistic regression was used to assess the relationship between KAP levels and child colonization with ESBL-EC. Results We analyzed 740 stool samples from 444 children living in households representing a range of environmental conditions. Of 374 children who provided fecal samples at the first household visit, 44 children were colonized with ESBL-EC (11.8%) and 161 were colonized with multidrug-resistant E. coli (43%). The prevalences of ESBL-EC and multidrug-resistant E. coli were similar at the second visit (11.2% and 41.3%, respectively; N = 366). Only 8% of caretakers knew that antibiotics killed bacteria but not viruses, and over a third reported that they “always” give their children antibiotics when the child’s throat hurts (35%). Few associations were observed between KAP variables and ESBL-EC carriage among children. The odds of ESBL-EC carriage were 2.17 times greater (95% CI: 1.18–3.99) among children whose caregivers incorrectly stated that antibiotics do not kill bacteria compared to children whose caregivers correctly stated that antibiotics kill bacteria. Children from households where the caretaker answered the question “When your child’s throat hurts, do you give them antibiotics?” with “sometimes” had lower odds of ESBL-EC carriage than those with a caretaker response of “never” (OR 0.48, 95% CI 0.27–0.87). Conclusion Caregivers in our study population generally demonstrated low knowledge regarding appropriate use of antibiotics. Our findings suggest that misinformation about the types of infections (i.e. bacterial or viral) antibiotics should be used for may be associated with elevated odds of carriage of ESBL-EC. Understanding that using antibiotics is appropriate to treat infections some of the time may reduce the odds of ESBL-EC carriage. Overall, however, KAP measures of appropriate use of antibiotics were not strongly associated with ESBL-EC carriage. Other individual- and community-level environmental factors may overshadow the effect of KAP on ESBL-EC colonization. Intervention studies are needed to assess the true effect of improving KAP on laboratory-confirmed carriage of antimicrobial resistant bacteria, and should consider community-level studies for more effective management.

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Relating knowledge, attitude and practice of antibiotic use to extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage: results of a cross-sectional community survey

Cited by 21 publications

References 34 publications

Antibiotic use and resistance: an unprecedented assessment of university students’ knowledge, attitude and practices (KAP) in Lebanon

Antibiotic use and resistance: an unprecedented assessment of university students’ knowledge, attitude and practices (KAP) in Lebanon

Risk factors for fecal carriage of drug-resistant Escherichia coli: a systematic review and meta-analysis

Caretaker knowledge, attitudes, and practices (KAP) and carriage of extended-spectrum beta-lactamase-producing E. coli (ESBL-EC) in children in Quito, Ecuador

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