1411. Antibiotic-Resistance and Carbapenem-Resistant Enterobacteriaceae (CRE): Assessment of Clinical Knowledge and Practices in Non-Infectious Disease Trained Clinicians in the Hospital
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
  • IDSA2012_Thibodeau.Final.jpg (9.1 MB)
  • Background: Gram negative antibiotic resistance is increasing worldwide as both CREs and Enterobacteriaceae producing extended spectrum -lactamases (ESBLs) become more common. We analyzed knowledge levels of clinicians regarding these types of organisms since their knowledge of infection control practices, prescribing practices and assessment of their patients' risk for resistant infections might help limit their spread.

    Methods: Questionnaires were sent to 3 Tufts-affiliated teaching hospitals. Target populations included clinicians who prescribe antibiotics: medical doctors and mid-level practitioners. Questions were asked regarding knowledge, treatments, and risk assessment in regard to resistant gram-negative infections.

    Results: We received 434 responses from 3332 clinicians (13%) surveyed at the three hospitals; 15 responses from Infectious Disease specialists were omitted from the final analysis leaving 419 responses. 51.1% of clinicians correctly scored 50% or greater on the knowledge questions. Internal medicine clinicians had higher knowledge scores than non-internal medicine clinicians (62% vs 45%; OR=1.67, p= 0.02). Clinicians within three years of training had higher scores than those with more than 10 years of training (64.3% vs 44% OR=2.3, p=0.002). 54.4% of clinicians were very concerned about gram-negative antibiotic resistance. Clinicians with fewer years since training (figure 1) and those with higher knowledge scores were more likely to appropriately consider certain patients at risk for resistant infections (p<0.05). 64.6% of clinicians felt comfortable de-escalating antibiotics as cultures are available.

    Conclusion: We found overall low knowledge scores and variable risk assessments of certain patient populations regarding antibiotic resistant Gram negatives: Internal medicine clinicians and those with fewer years since completion of their training scored higher and more appropriately considered patients at risk for resistance. The majority of clinicians are concerned about gram-negative resistance and indicated they would de-escalate antibiotic therapy if they had susceptibility information. These results will help focus and target our teaching and awareness-raising strategies.


    Evangeline Thibodeau, MD, MPH1, Shira Doron, MD1, Vito Iacoviello, MD2, Jennifer Schimmel, MD3 and David Snydman, MD, FIDSA1, (1)Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, (2)Infectious Disease, Saint Elizabeths Medical Center, Brighton, MA, (3)Infectious Disease, Baystate Medical Center, Springfield, MA


    E. Thibodeau, Merck: Grant Investigator, Research grant

    S. Doron, Merck: Grant Investigator, Grant recipient
    Forest: Speaker's Bureau, Speaker honorarium

    V. Iacoviello, Gilead: Consultant, Consulting fee
    CRICO: Expert Witness, Other

    J. Schimmel, None

    D. Snydman, Genentech: Consultant and Grant Investigator, Consulting fee, Grant recipient and Speaker honorarium
    Millenium: Consultant, Consulting fee
    Genzyme: Consultant, Consulting fee
    Boeringer Ingelheim: Consultant, Consulting fee
    Wyeth: Consultant, Consulting fee
    Massachusetts Biologic Public health Laboratories: Consultant, Consulting fee
    Schering Plough: Consultant, Consulting fee
    Merck: Grant Investigator, Research grant and Speaker honorarium
    Cubist: Grant Investigator, Research grant and Speaker honorarium
    Optimer: Investigator, Research grant
    Pfizer: Grant Investigator, Research grant
    Novartis: Consultant, Travel/accommodations expenses covered or reimbursed

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.