Methods: We conducted a qualitative study at a tertiary care hospital in Switzerland during 2011. We interviewed 21 internal medicine residents and attending physicians selected by purposive sampling, using a semi-structured questionnaire. Responses were analyzed in an inductive thematic content approach using dedicated software (MAXQDA®).
Results: In the 21 interviews, the following thematic rationales for antibiotic overtreatment of ASB were reported (in order of reporting frequency): 1) Treating laboratory findings without taking the clinical picture into account (n=17); 2) Psychological factors such as anxiousness, overcautiousness or anticipated positive impact on patient outcomes (n=13); 3) External pressors such as institutional culture, peer pressure, patient expectation, and excessive workload that interferes with proper decision-making (n=9); 4) Difficulty with interpreting clinical signs and symptoms (n=8).
Conclusion: In this qualitative study we identified both physician-centered factors (e.g., overcautiousness) and external pressors (e.g., excessive workload) as motivators for prescribing unnecessary antibiotics. Also, we interpreted the frequently cited practice of treating asymptomatic patients based on laboratory findings alone as lack of awareness of evidence-based best practices.
D. Aujesky, None
J. Marschall, None
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