Methods: Anonymous, cross-sectional survey of residents from University of Washington Family Medicine, General Surgery, Internal Medicine, and Neurology programs.
Results: 112 of 264 eligible residents responded to questions in two domains.
1) Antibiotic Use Patterns: 52% of respondents “often” or “always” felt comfortable prescribing antibiotics in the hospital and 46% in the clinic. 70% “frequently” or “always” sought the opinion of the team's more senior clinician. 48% “never,” “rarely,” or “occasionally” consulted an infectious diseases (ID) specialist.
2) Antibiotic Knowledge: 72% correctly chose not to treat asymptomatic bacteriuria in a patient with an indwelling catheter. For pyelonephritis, 79% chose therapy consistent with Infectious Diseases Society of America (IDSA) guidelines, but only 15% chose the correct initial treatment length. For community acquired pneumonia, 55% chose one of three acceptable outpatient regimens, but 30% chose 5 day treatment, 43% chose 7 days, and 8% chose 10 or more days. For cellulitis with a nasal methicillin-resistant staphylococcus aureus (MRSA) swab positive, 70% treated empirically for MRSA. Antibiotic choice ranged from broad-spectrum intravenous antibiotics to narrow-spectrum oral agents; durations ranged from 5-14 days.
Conclusion: Participants in this study do not prescribe antibiotics in a uniform, systematic way. Results show a tendency towards prescribing broader spectrum, longer courses than recommended IDSA guidelines. Half of respondents never or rarely consult ID, instead deferring to more senior clinicians on their team. This reflects their reported discomfort and suggests that inconsistency stems from a current education system in which residents learn mostly by direct clinical interaction with clinicians of varying skill and interests, and without a supportive curriculum to help understand existing guidelines. Medical school curricular changes are warranted to improve graduates’ baseline knowledge. Residents would also benefit from supplemental teaching resources to improve appropriateness of antibiotic use.