[Lack of information and provision of information at the workplace as potential reasons for inappropriate antibiotic therapy in Germany]

Abstract

Background: The increased use of antibiotics leads to a rise in drug-resistant bacteria. It is critical to reduce inadequate prescribing of antibiotics in order to prevent a post-antibiotic era.

Aim of the study: To explore if healthcare providers in Germany have access to current treatment guidelines, information about antibiotics and local resistance data at their workplace and how they access the information in their daily routine.

Methods: An anonymous online survey was performed with hospital-based physicians, office-based medical doctors and medical students in their last year of medical training in Germany.

Results: 1,428 participants completed the questionnaire with a return rate of 8.4 % (n=1,428/17,055). Lack of knowledge, preexisting prescription patterns and lack of data (local resistance data, drug information) were the most frequent reasons for the inadequate use of antibiotics given by the participants. 37 % of hospital doctors (n=404/1,091) cannot access local resistance data at their workplace, 26.2 % (n=286/1,091) lack standard operating procedures (SOP), 23.2 % (n=253/1,090) have no access to a database of national guidelines and 23.7 % (n=259/1,091) cannot access a drug information database. When asked about the sources of information they frequently used when prescribing antibiotics, 27.3 % (n=341/1,251) of the participants said that they used digital media at least once a day, 17.8 % (n=223/1,251) asked their colleagues, and 11.5 % (n=143/1,249) resorted to analogue media (e.g., print media). In order to improve antibiotic prescribing practices, participants were asked to rate the effectiveness of a potential clinical decision support system (CDSS) integrating local resistance data, drug information and local SOPs at their workplace. On a scale of 1 (= very useful) to 6 (= very useless), the anticipated effectiveness of such a tool was rated as "useful" or "very useful" with 1.67±1.01.

Conclusion: In our study, lack of knowledge and lack of local data at the workplace were considered the most important reasons for the inadequate prescribing of antibiotics. Because the majority of healthcare providers use digital media as an information source, there is a clear desire for an easily accessible CDSS integrating all necessary data. Further studies will have to show whether a CDSS can improve and sustain the quality of antibiotic prescribing.

Keywords: Antibiotic Stewardship; Antibiotic resistance; Antibiotic stewardship; Antibiotic therapy; Antibiotikaresistenzen; Antibiotikatherapie; Clinical Decision Support System; Clinical decision support system.