Rationalizing irrational prescribing-infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India.

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-07-13 eCollection Date: 2024-08-01 DOI:10.1093/jacamr/dlae105
Surya Surendran, Vrinda Nampoothiri, Puneet Dhar, Alison Holmes, Sanjeev Singh, Esmita Charani
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Abstract

Background and objectives: Antibiotic use in paediatric surgical specialties is understudied. We investigated the antibiotic prescribing practices of paediatric general and cardiovascular surgical teams in a tertiary hospital in South India.

Methods: Mixed-methods study including observations from ward rounds, semi-structured interviews, and review of antibiotic prescribing. Field notes from observations and interview transcripts were coded using NVivo and thematically analysed. Data collection and analysis were iterative and continued until thematic saturation. Quantitative data were analysed using descriptive statistics.

Results: Data included 62 h of observation, 24 interviews, one case study and 200 patient chart reviews (100/specialty). Senior surgeons make key decisions, referring to their own experience when prescribing antibiotics. Being outcome-driven, the doctors often prescribe antibiotics at the earliest indication of infection with a reluctance to de-escalate, even when an infection is not diagnosed. This practice is more acute among surgeons who consider themselves responsible for their patients' health and attribute the consistently low surgical site infection rates to this practice.In general surgery, 83.3% (80/96; 4 lost to follow-up) of patients were prescribed antibiotics for the duration of their stay with oral antibiotics prescribed at discharge. The surgeons use antibiotics prophylactically for patients who may be vulnerable to infection. The antimicrobial stewardship team was considered to have limited influence in the decision-making process.

Conclusions: Outcome-driven decision-making in surgery leads to overprescription of antibiotics and prolonged surgical prophylaxis. The rationale for suboptimal practices is complicated by the surgeons' beliefs about the contextual determinants of health in India.

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印度南部一家医院儿科外科各专科不合理处方的合理化--与感染相关的态度和做法。
背景和目的:对儿科外科抗生素使用的研究不足。我们调查了南印度一家三级医院儿科普通外科和心血管外科团队的抗生素处方实践:混合方法研究,包括查房观察、半结构化访谈和抗生素处方审查。使用 NVivo 对观察记录和访谈记录进行编码,并进行主题分析。数据收集和分析是反复进行的,一直持续到主题饱和为止。定量数据采用描述性统计进行分析:数据包括 62 小时的观察、24 次访谈、一项案例研究和 200 份病历回顾(100 份/专科)。资深外科医生在开具抗生素处方时,会参考自己的经验做出关键决定。由于以结果为导向,医生们往往在出现感染迹象时就开具抗生素处方,即使在未确诊感染的情况下也不愿降级。在普外科,83.3%(80/96;4 例失去随访)的患者在住院期间使用抗生素,出院时使用口服抗生素。外科医生会对易受感染的患者预防性使用抗生素。抗菌药物管理小组在决策过程中的影响力有限:结论:外科手术中以结果为导向的决策会导致抗生素处方过量和手术预防时间过长。外科医生对印度健康环境决定因素的看法使次优做法的理由变得更加复杂。
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来源期刊
CiteScore
5.30
自引率
0.00%
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0
审稿时长
16 weeks
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