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Empiric Antibiotic Prescribing Decisions Among Medical Residents: The Role of the Antibiogram

Published online by Cambridge University Press:  01 March 2018

Gregory B. Tallman ,
Rowena A. Vilches-Tran ,
Miriam R. Elman ,
David T. Bearden ,
Jerusha E. Taylor ,
Paul N. Gorman  and
Jessina C. McGregor
Gregory B. Tallman*
Affiliation:
Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland, Oregon
Rowena A. Vilches-Tran
Affiliation:
Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland, Oregon
Miriam R. Elman
Affiliation:
Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland, Oregon
David T. Bearden
Affiliation:
Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland, Oregon Department of Pharmacy Services, Oregon Health and Science University Hospital, Portland, Oregon
Jerusha E. Taylor
Affiliation:
Department of Pharmacy Services, Oregon Health and Science University Hospital, Portland, Oregon
Paul N. Gorman
Affiliation:
Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon. (Present affiliation: Outpatient Pharmacy Department, Kaiser Permanente, Manteca, California [R.A.V.T.].)
Jessina C. McGregor
Affiliation:
Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland, Oregon
*
Address correspondence to Gregory B. Tallman, PharmD, MS, 2730 SW Moody Ave, CL5CP, Portland, OR 97201 (tallmang@ohsu.edu) or Jessina C. McGregor, PhD, 2730 SW Moody Ave, CL5CP, Portland, OR 97201 (mcgregoj@ohsu.edu).
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Abstract

OBJECTIVE

To assess general medical residents’ familiarity with antibiograms using a self-administered survey

DESIGN

Cross-sectional, single-center survey

PARTICIPANTS

Residents in internal medicine, family medicine, and pediatrics at an academic medical center

METHODS

Participants were administered an anonymous survey at our institution during regularly scheduled educational conferences between January and May 2012. Questions collected data regarding demographics, professional training; further open-ended questions assessed knowledge and use of antibiograms regarding possible pathogens, antibiotic regimens, and prescribing resources for 2 clinical vignettes; a series of directed, closed-ended questions followed. Bivariate analyses to compare responses between residency programs were performed.

RESULTS

Of 122 surveys distributed, 106 residents (87%) responded; internal medicine residents accounted for 69% of responses. More than 20% of residents could not accurately identify pathogens to target with empiric therapy or select therapy with an appropriate spectrum of activity in response to the clinical vignettes; correct identification of potential pathogens was not associated with selecting appropriate therapy. Only 12% of respondents identified antibiograms as a resource when prescribing empiric antibiotic therapy for scenarios in the vignettes, with most selecting the UpToDate online clinical decision support resource or The Sanford Guide. When directly questioned, 89% reported awareness of institutional antibiograms, but only 70% felt comfortable using them and only 44% knew how to access them.

CONCLUSIONS

When selecting empiric antibiotics, many residents are not comfortable using antibiograms as part of treatment decisions. Efforts to improve antibiotic use may benefit from residents being given additional education on both infectious diseases pharmacotherapy and antibiogram utilization.

Infect Control Hosp Epidemiol 2018;39:578–583

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 5 , May 2018 , pp. 578 - 583
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. These data were presented in part at the American Society of Health-System Pharmacists 47th Annual Midyear Clinical Meeting on December 3, 2012, in Las Vegas, Nevada.

References

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