title: Providers' beliefs and behaviors regarding antibiotic prescribing and antibiotic resistance in persons with spinal cord injury or disorder.
abstract: BACKGROUND
  Persons with spinal cord injury or disorder (SCI/D) are at increased risk for antibiotic resistance because of recurrent infections and subsequent use of antibiotics. However, there are no studies focused on providers who care for these patients and their perceptions regarding antibiotic use and resistance.
  
  
  OBJECTIVE
  To characterize SCI/D provider behavior and attitudes about antibiotic prescribing and resistance.
  
  
  METHODS
  Anonymous internet-based, cross-sectional survey.
  
  
  METHODS
  A total of 314 SCI/D clinicians who prescribe antibiotics (physicians, physician assistants, and nurse practitioners).
  
  
  RESULTS
  A total of 118 providers responded (37.6% response rate) including 80 physicians, 20 nurse practitioners, and 18 physician assistants. The majority of respondents agreed with statements regarding the societal impact of antibiotic resistance; only 17.8% agreed that they prescribed antibiotics more than they should, but 61.0% agreed that patient demand was a major reason for prescribing unnecessary antibiotics. The most frequent problematic organisms reported were: methicillin-resistant Staphylococcus aureus (83.1%), multidrug-resistant Pseudomonas (61.0%), and Clostridium difficile (57.6%). The most frequent antibiotics selected for outpatient treatment of community-acquired pneumonia treatment, based on a clinical scenario were azithromycin (36.4%) and respiratory fluoroquinolones (22.9%).
  
  
  CONCLUSIONS
  These data show that the respondents are aware of and concerned with the problem of antibiotic resistance in their practice. Clinician respondents also endorsed the need to improve their own knowledge and that of their colleagues regarding appropriate antibiotic prescribing. These findings suggest that interventions should focus on provider education, particularly regarding appropriate antibiotic prescribing.
authors.affiliation: Center for Management of Complex Chronic Care, Edward J. Hines VA Hospital, IL 60141, USA. Charlesnika.Evans@va.gov
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
authors.forename: Thea J
authors.initials: TJ
authors.lastname: Rogers
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Burns
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology*; D004352:Drug Resistance, Microbial; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000523:psychology; D010823:Physician Assistants / Q000523:psychology; D010820:Physicians / Q000523:psychology; D011364:Professional Practice / Q000706:statistics & numerical data*; D013119:Spinal Cord Injuries / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents