title: A survey of physicians' knowledge and attitudes regarding antimicrobial resistance and antibiotic prescribing practices at the University Hospital of the West Indies.
abstract: OBJECTIVE
  To identify physicians' knowledge and attitudes regarding antimicrobial resistance and antibiotic prescribing practices at the University Hospital of the West Indies (UHWI).
  
  
  METHODS
  A cross-sectional survey of physicians at the UHWI was conducted between September 2008 and April 2009 using a 28-item, self-administered questionnaire. Eligible physicians from several specialities were identified from departmental rotas.
  
  
  RESULTS
  A total of 174 physicians completed the questionnaire, a response rate of 73%. Most physicians considered antibiotic resistance to be an extremely important global problem (55%) but less significant nationally (35%). Factors identified as important in producing resistance included widespread use of antibiotics (91%), inappropriate empiric choices (79%) and use of broad-spectrum agents (70%). Hand-washing was not considered to be important in reducing resistance. Useful interventions included access to current information on local resistance patterns (90%), institutional specific antibiotic guidelines (89%) and educational programmes (89%). Antibiotic cycling (40%) and restriction (35%) were regarded as less helpful. Knowledge of resistance-prone antibiotics and specific resistant organisms at the UHWI was poor, except for methicillin-resistant Staphylococcus aureus (MRSA). Empiric therapy for common infections was appropriate in most cases, and antibiotic choices were guided by availability of drugs (89%) and patient factors such as renal disease or allergy (80%). Only 45% of physicians would de-escalate to a narrow-spectrum antibiotic guided by a microbiology report, and consultants were more likely to de-escalate therapy than junior staff (p = 0.002).
  
  
  CONCLUSIONS
  Although physicians were aware of the problem of resistance to antibiotics and the contributory factors, their practice did not reflect measures to reduce it. Continuing educational programmes and institution-specific antibiotic prescribing guidelines are needed.
authors.affiliation: Department of Surgery, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica, West Indies. ingrid@ac-martin.com
authors.forename: I
authors.initials: I
authors.lastname: Tennant
authors.forename: A
authors.initials: A
authors.lastname: Nicholson
authors.forename: G M
authors.initials: GM
authors.lastname: Gordon-Strachan
authors.forename: C
authors.initials: C
authors.lastname: Thoms
authors.forename: C
authors.initials: C
authors.lastname: Thomas
authors.forename: V
authors.initials: V
authors.lastname: Chin
authors.forename: M A
authors.initials: MA
authors.lastname: Didier
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial; D005260:Female; D006235:Hand Disinfection; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'