Prescribers’ experience and opinions on antimicrobial stewardship programmes in hospitals: a French nationwide survey - EHESP - École des hautes études en santé publique
Journal Articles Journal of Antimicrobial Chemotherapy Year : 2019

Prescribers’ experience and opinions on antimicrobial stewardship programmes in hospitals: a French nationwide survey

A Perozziello
  • Function : Author
F Lescure
  • Function : Author
A Truel
  • Function : Author
L Vaillant
  • Function : Author
Y Yazdanpanah
  • Function : Author
J Lucet
  • Function : Author
Luong Nguyen Liem-Binh
  • Function : Author
Mourvillier Bruno
  • Function : Author
Zahar Jean-Ralph
  • Function : Author
Charles Burdet
  • Function : Author
Lidia Kardas
  • Function : Author
Raphaël Lepeule
  • Function : Author
Philippe Lesprit
  • Function : Author
François L’heriteau
  • Function : Author
Liem-Binh Luong Nguyen
  • Function : Author
Bruno Mourvillier
  • Function : Author
Jean-Ralph Zahar

Abstract

Objectives: To assess prescribers' experiences and opinions regarding antimicrobial stewardship programme (ASP) activities. Methods: A cross-sectional paper-based survey was conducted among prescribers in 27 out of 35 randomly selected large hospitals in France. Results: All 27 investigated hospitals (20 non-university public, 4 university-affiliated and 3 private hospitals) had an ASP and an appointed antibiotic advisor (AA), with a median of 0.9 full-time equivalents per 1000 acute-care beds (IQR 0-1.4). Of the 1963 distributed questionnaires, 920 were completed (46.9%). Respondents were mainly attending physicians (658/918, 71.7%) and medical specialists (532/868, 61.3%). Prescribers identified two main ASP objectives: to limit the spread of resistance (710/913, 77.8%) and to improve patient care and prognosis (695/913, 76.1%). The presence of an AA constituted a core element of ASP (96.2% agreement between answers of ASP leader and respondents). Respondents acknowledged an AA's usefulness especially on therapeutic issues, i.e. choosing appropriate antibiotic (agreement 84.7%) or adapting treatment (89.6%), but less so on diagnostic issues (31.4%). Very few respondents reported unsolicited counselling and post-prescription controls. Three-quarters of prescribers identified local guidelines (692/918, 75.4%). Prescribers did not approve of measures counteracting their autonomy, i.e. automatic stop orders (agreement 23.4%) or pre-approval by AAs (28.8%). They agreed more with educational interventions (73.0%) and clinical staff meetings (70.0%). Conclusions: Prescribers perceived ASP mainly through its 'on-demand' counselling activities. They preferred measures that did not challenge their clinical autonomy. High levels of antibiotic consumption in French hospitals bring into question the effectiveness of such an approach. However, limited ASP staffing and resources may preclude extended activities.
No file

Dates and versions

hal-03124038 , version 1 (28-01-2021)

Identifiers

Cite

A Perozziello, F Lescure, A Truel, Christelle Routelous, L Vaillant, et al.. Prescribers’ experience and opinions on antimicrobial stewardship programmes in hospitals: a French nationwide survey. Journal of Antimicrobial Chemotherapy, 2019, 74 (8), pp.2451-2458. ⟨10.1093/jac/dkz179⟩. ⟨hal-03124038⟩
69 View
0 Download

Altmetric

Share

More