title: Nursing home nurses' and community-dwelling older adults' reported knowledge, attitudes, and behavior toward antibiotic use.
abstract: BACKGROUND
  Antibiotic overuse causes antibiotic resistance, one of the most important threats to human health. Older adults, particularly those in nursing homes, often receive antibiotics when they are not indicated.
  
  
  METHODS
  To understand knowledge, attitudes, and behaviors of nursing home (NH) nurses and community-dwelling older adults towards antibiotic use, especially in clinical situations consistent with antibiotic overuse, we conducted a mixed-method survey in two NHs and one Family Medicine clinic in North Carolina, among English-speaking nurses and community-dwelling, cognitively intact adults aged 65 years or older. Based on the Knowledge-Attitude-Practice model, the survey assessed knowledge, attitudes, and behavior towards antibiotic use, including three vignettes designed to elicit possible antibiotic overuse: asymptomatic bacteriuria (ASB), a viral upper respiratory illness (URI), and a wound from a fall.
  
  
  RESULTS
  Of 31 NH nurses and 66 community-dwelling older adults, 70% reported knowledge of the dangers of taking antibiotics. Nurses more often reported evidence-based attitudes towards antibiotics than older adults, except 39% agreed with the statement "by the time I am sick enough to go to the doctor with a cold, I expect an antibiotic", while only 28% of older adults agreed with it. A majority of nurses did not see the need for antibiotics in any of the three vignettes: 77% for the ASB vignette, 87% for the URI vignette, and 97% for the wound vignette. Among older adults, 50% did not perceive a need for antibiotics in the ASB vignette, 58% in the URI vignette, and 74% in the wound vignette.
  
  
  CONCLUSIONS
  While a substantial minority had no knowledge of the dangers of antibiotic use, non-evidence-based attitudes towards antibiotics, and behaviors indicating inappropriate management of suspected infections, most NH nurses and community-dwelling older adults know the harms of antibiotic use and demonstrate evidence-based attitudes and behaviors. However, more work is needed to improve the knowledge, attitudes and behaviors that may contribute to antibiotic overuse.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, Department of Family Medicine, University of North Carolina, Chapel Hill, NC USA.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Kistler
authors.affiliation: Cecil G. Sheps Center for Health Services Research, School of Nursing, University of North Carolina, Chapel Hill, NC USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Beeber
authors.affiliation: Department of Family Medicine, University of North Carolina, Chapel Hill, NC USA.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Becker-Dreps
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Ward
authors.affiliation: School of Medicine, University of North Carolina, Chapel Hill, NC USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Meade
authors.affiliation: School of Medicine, University of North Carolina, Chapel Hill, NC USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Ross
authors.affiliation: Cecil G. Sheps Center for Health Services Research, Department of Family Medicine, University of North Carolina, Chapel Hill, NC USA.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
keywords: Infection management; Nursing homes; Older adults; Primary care