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Published on: August 30, 2018
Physicians' perspectives on antimicrobial resistance and rational antibiotic prescribing
Rodrigo Villaseñor-Echavarri1, Mariana Velez-Pintado2
1Department of Internal Medicine, The American British Cowdray Medical Center, Mexico City, Mexico; School of Medicine, Universidad Panamericana, Mexico City, Mexico.
Background:
Antimicrobial resistance poses a growing global threat. In real-world practice, antimicrobial prescribing is shaped by clinicians' cognitive biases and perceptions of resistance risk, potentially driving unnecessary broad-spectrum antibiotic use and increased antimicrobial pressure.
Methods:
We conducted a questionnaire-based study among physicians to assess perceptions on antimicrobial resistance magnitude, determinants of prescription, and barriers to de-escalation. Clinician-estimated resistance rates were compared with observed data, and the main factors influencing antimicrobial prescription were analyzed.
Results:
82 physicians were surveyed; 76% were attendings; 37% internal medicine, 30% pediatrics, and 11% infectious diseases (adult and pediatric). Clinicians consistently overestimated carbapenem-resistant (CR) Klebsiella pneumoniae and Escherichia coli, methicillin-resistant Staphylococcus aureus, and VRE (Holm-adjusted P < .001). Non-ID clinicians overestimated resistance rates compared with ID physicians (CR E coli 26.7% vs 8.8%, CR K pneumoniae 23.4% vs 10.0%, MRSA 35.6% vs 16.6%, and vancomycin-resistant Enterococcus spp 28.3% vs 12.2%, all P < .05).
Conclusions:
This study reveals a gap between perceived and observed resistance rates, indicating cognitive biases that favor broad empirical therapy and delayed de-escalation. Differences by specialty underscore the role of specialized training, while fear- and severity-driven decision-making reflects a defensive prescribing approach that may undermine antimicrobial stewardship efforts.
Insights
Physicians overestimate antimicrobial resistance, leading to broad-spectrum antibiotic use. Addressing cognitive biases and specialty differences is key for antimicrobial stewardship.
Area of Science:
- Medical Science
- Infectious Diseases
- Public Health
Background:
- Antimicrobial resistance (AMR) is a significant global health challenge.
- Clinician cognitive biases and risk perception influence antimicrobial prescribing, potentially increasing broad-spectrum antibiotic use and resistance pressure.
Purpose of the Study:
- To assess physicians' perceptions of AMR magnitude and prescription determinants.
- To compare clinician-estimated resistance rates with observed data.
- To identify barriers to antimicrobial de-escalation.
Main Methods:
- A questionnaire-based study surveyed 82 physicians (76% attendings).
- Assessed perceptions of AMR, prescription drivers, and de-escalation barriers.
- Compared clinician-estimated resistance rates with actual data.
Main Results:
- Physicians consistently overestimated rates of carbapenem-resistant K. pneumoniae, E. coli, MRSA, and VRE.
- Non-infectious disease (ID) clinicians showed higher overestimation compared to ID physicians.
- Significant differences in overestimation were observed across various resistant organisms (p < 0.05).
Conclusions:
- A notable gap exists between perceived and actual resistance rates, driven by cognitive biases.
- These biases favor empirical broad-spectrum therapy and delay de-escalation, undermining stewardship.
- Specialty training and defensive prescribing practices impact antimicrobial decision-making.
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