A questionnaire based survey among pharmacy practitioners to evaluate the level of knowledge and confidence towards antimicrobial stewardship
Main Article Content
Antimicrobial resistance, Pharmacists, Antimicrobial stewardship, Knowledge, Confidence, Stewards
Objective: Our study aimed to assess the knowledge, understanding and confidence of the practicing pharmacists in UAE as an antimicrobial Stewards. Antimicrobial resistance threatens the achievements of modern medicine globally, and it’s highly required for the AMS principles to be implemented in our communities. Methods: A cross-sectional online- questionnaire based survey was used among UAE pharmacy practitioners from different areas of practice who are holding pharmaceutical degrees and/or licensed pharmacists. The questionnaire was sent to the participants via social media platforms. The questionnaire was validated, and reliability assessment was made prior to the conduct. Results: A total of 117 pharmacists responded to this study, out of which (70.9%, n=83) were females. Pharmacists which are from various practice fields participated in the survey, but the majority were pharmacists in Hospital pharmacies or Clinical pharmacists (47%, n=55), also community pharmacists (35.9%, n=42), while only (16.9%, n=20) ware from other areas of pharmacy including industrial pharmacy and academia. The majority of participants 88.9% (n= 104) were interested in pursuing their career as an Infectious disease pharmacist or getting a certificate in antimicrobial stewardship. The mean scores in the knowledge towards antimicrobial resistance was 3.75 (poor: 1-1.6, moderate: 1.7-3.3, Good: 3.4-5), indicates that the pharmacists have a good level of knowledge towards AMR. A total of 84.3% of participants succeeded in Identifying the correct intervention for antibiotic resistance. The findings also showed that the total mean score of hospital pharmacists (mean=10.6±1.12), and the average of the scores of community pharmacists (mean=9.8±1.38), were non-significant between the different area of practice. 52.3% of the participants had a training on antimicrobial stewardship during their experiential rotation which reflected on their confidence in their performance and knowledge assessment (p value < 0.05). Conclusion: The study concluded good knowledge and high confidence levels among practicing pharmacists in UAE. However, the findings also identify areas of improvement in the practicing pharmacist, and the significant relationship between the knowledge and confidence scores reflects the ability of the practicing pharmacists to integrate the AMS principles within the UAE, which aligns with the attainability of the improvement
2. Thomas B, Abdulrouf P, Elkassem W, et al. Clinical and economic impact of antimicrobial stewardship interventions reported among hospital inpatients in the Middle East: a systematic review protocol. 2020.
3. MacBrayne CE, Williams MC, Levek C, et al. Sustainability of handshake stewardship: extending a hand is effective years later.Clinical Infectious Diseases. 2020;70(11):2325-2332. https://doi.org/10.1093/cid/ciz650
4. Karanika S, Paudel S, Grigoras C, et al. Systematic review and meta-analysis of clinical and economic outcomes from the implementation of hospital-based antimicrobial stewardship programs. Antimicrobial Agents and Chemotherapy.2016;60(8):4840-4852. https://doi.org/10.3410/f.726394411.793522941
5. Pinder RJ, Berry D, Sallis A, et al. Antibiotic prescribing and behavior change in healthcare settings: literature review and behavioral analysis. 2015.
6. Aryee A, Price N. Antimicrobial stewardship–can we afford to do without it? British Journal of Clinical Pharmacology.2015;79(2):173-181. https://doi.org/10.1111/bcp.12417
7. Haddadin RN, Alsous M, Wazaify M, et al. Evaluation of antibiotic dispensing practice in community pharmacies in Jordan: Across sectional study. PloS One. 2019;14(4):e0216115. https://doi.org/10.1371/journal.pone.0216115
8. Raza UA, Khursheed T, Irfan M, et al. Prescription patterns of general practitioners in Peshawar, Pakistan. Pakistan Journal of Medical Sciences. 2014;30(3):462. https://doi.org/10.12669/pjms.303.4931
9. Saleh D, Abu-Farha R, Mukattash TL, et al. Views of community pharmacists on antimicrobial resistance and antimicrobial stewardship in Jordan: A qualitative study. Antibiotics. 2021;10(4):384. https://doi.org/10.3390/antibiotics10040384
10. Pinder RJ, Berry D, Sallis A, et al. Antibiotic prescribing and behaviour change in healthcare settings: literature review andbehav
11. Bai Y, Wang S, Yin X, et al. Factors associated with doctors’ knowledge on antibiotic use in China. Scientific Reports. 2016;6(1):1-5. https://doi.org/10.1038/srep23429
12. Barchitta M, Sabbatucci M, Furiozzi F, et al. Knowledge, attitudes and behaviors on antibiotic use and resistance among healthcare workers in Italy, 2019: Investigation by a clustering method. Antimicrobial Resistance & Infection Control.2021;10(1):1-10. https://doi.org/10.1186/s13756-021-01002-w
13. World Health Organization. Pharmacists have decisive role in combating antibiotic resistance, says new WHO European survey.2014. WHO Regional Office for Europe. 2017.
14. Wickens HJ, Farrell S, Ashiru-Oredope DA, et al. Antimicrobial Stewardship Group of the Department of Health Advisory Committee on Antimicrobial Resistance and Health Care Associated Infections (ASG-ARHAI), Cooke J, Sharland M, Ashiru-
Oredope D, McNulty C, Dryden M. The increasing role of pharmacists in antimicrobial stewardship in English hospitals. Journal of Antimicrobial Chemotherapy. 2013;68(11):2675-2681. https://doi.org/10.1093/jac/dkt241
15. Nasr ZG, Higazy A, Wilbur K. Exploring the gaps between education and pharmacy practice on antimicrobial stewardship:a qualitative study among pharmacists in Qatar. Advances in Medical Education and Practice. 2019;10:287. https://doi.org/10.2147/amep.s198343
16. World Health Organization. Pharmacists have decisive role in combating antibiotic resistance, says new WHO European survey.
2014. WHO Regional Office for Europe. 2017.
17. Scaioli G, Gualano MR, Gili R, et al. Antibiotic use: a cross-sectional survey assessing the knowledge, attitudes and practices amongst students of a school of medicine in Italy. PloS One. 2015;10(4):e0122476. https://doi.org/10.1371/journal. pone.0122476
18. Rodrigues AT, Roque F, Falcão A, et al. Understanding physician antibiotic prescribing behaviour: a systematic review of qualitative studies. International Journal of Antimicrobial Agents. 2013;41(3):203-12. https://doi.org/10.1016/j.ijantimicag.2012.09.003
19. Karanika S, Paudel S, Grigoras C, et al. Systematic review and meta-analysis of clinical and economic outcomes from the implementation of hospital-based antimicrobial stewardship programs. Antimicrobial Agents and Chemotherapy.2016;60(8):4840-4852. https://doi.org/10.3410/f.726394411.793522941
20. Pollack LA, Srinivasan A. Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention. Clinical Infectious Diseases. 2014;59(suppl_3):S97-100. https://doi.org/10.1093/cid/ciu542
21. Wickens HJ, Farrell S, Ashiru-Oredope DA, et al. Antimicrobial Stewardship Group of the Department of Health Advisory Committee on Antimicrobial Resistance and Health Care Associated Infections (ASG-ARHAI), Cooke J, Sharland M, Ashiru-Oredope D, McNulty C, Dryden M. The increasing role of pharmacists in antimicrobial stewardship in English hospitals. Journal
of Antimicrobial Chemotherapy. 2013;68(11):2675-2681. https://doi.org/10.1093/jac/dkt241
22. Akkawi ME, Al-Shami N, Al-Worafi YM, et al. Knowledge, Attitude, and Practice Towards Antibiotic Use Among the Public in the City of Kuantan, Pahang State, Malaysia. Journal of Pharmacy. 2022;2(2):149-158. https://doi.org/10.37231/ajmb.2021.5.s2.456
23. Cotta MO, Robertson MS, Tecey M, et al. Attitudes towards antimicrobial stewardship: results from a large private hospital in Australia. Healthcare Infection. 2014;19(3):89-94. https://doi.org/10.1071/hi14008
24. Foreman BJ, Westerhof L, Benzer J, et al. Impact of order sentence implementation on outpatient antibiotic prescribing for urinary tract infection and skin and soft tissue infection. Journal of the American College of Clinical Pharmacy. 2022;5(3):283-290. https://doi.org/10.1002/jac5.1578
25. Lim CJ, Kwong M, Stuart RL, et al. Antimicrobial stewardship in residential aged care facilities: need and readiness assessment.BMC Infectious Diseases. 2014;14(1):1-0. https://doi.org/10.1186/1471-2334-14-410
26. Cassidy SS, Sanders DJ, Wade J, et al. Antimicrobial surfaces: A need for stewardship? PLoS Pathogens. 2020;16(10):e1008880.
27. Dyar OJ, Huttner B, Schouten J, et al. What is antimicrobial stewardship? Clinical Microbiology and Infection. 2017;23(11):793-798.
28. Pulcini C, Morel CM, Tacconelli E, et al. Human resources estimates and funding for antibiotic stewardship teams are urgently
needed. Clinical Microbiology and Infection. 2017;23(11):785-787. https://doi.org/10.1016/j.cmi.2018.01.009
29. Abbo LM, Cosgrove SE, Pottinger PS, et al. Medical students’ perceptions and knowledge about antimicrobial stewardship:how are we educating our future prescribers? Clinical Infectious Diseases. 2013;57(5):631-638. https://doi.org/10.1093/cid/cit370
30. Thomas B, Abdulrouf P, Elkassem W, et al. Clinical and economic impact of antimicrobial stewardship interventions reported among hospital inpatients in the Middle East: a systematic review protocol. https://doi.org/10.21203/rs.3.rs-50679/v1
31. Dellit TH, Owens RC, McGowan JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clinical Infectious Diseases.2007;44(2):159-177. https://doi.org/10.1097/ipc.0b013e318068b1c0
32. Tahoon MA, Khalil MM, Hammad E, et al. The effect of educational intervention on healthcare providers’ knowledge, attitude, & practice towards antimicrobial stewardship program at, National Liver Institute, Egypt. Egyptian Liver Journal. 2020;10(1):1-7. https://doi.org/10.1186/s43066-019-0016-5
33. Satterfield J, Miesner AR, Percival KM. The role of education in antimicrobial stewardship. Journal of Hospital Infection.2020;105(2):130-141. https://doi.org/10.1016/j.jhin.2020.03.028
34. Pisano J, Pettit N, Bartlett A, et al. Social media as a tool for antimicrobial stewardship. American Journal of Infection Control.2016;44(11):1231-1236. https://doi.org/10.1016/j.ajic.2016.11.023
35. Lubwama M, Onyuka J, Ayazika KT, et al. Knowledge, attitudes, and perceptions about antibiotic use and antimicrobial resistance among final year undergraduate medical and pharmacy students at three universities in East Africa. Plos One. 2021;16(5):e0251301. ttps://doi.org/10.1371/journal.pone.0251301
36. Behaviour change and antibiotic prescribing in healthcare settings Literature review and behavioural analysis, 2015 Feb, https://spiral.imperial.ac.uk/bitstream/10044/1/22194/2/Behaviour_Change_for_Antibiotic_Prescribing_-_FINAL.pdf 2022;15.
37. Akbar Z, Alquwez N, Alsolais A, et al. Knowledge about antibiotics and antibiotic resistance among health-related students in a Saudi University. The Journal of Infection in Developing Countries. 2021;15(7):925-933. https://doi.org/10.3855/jidc.12329
38. Kullar R, Nagel J, Bleasdale SC, et al. Going for the gold: a description of the centers of excellence designation by the Infectious
Diseases Society of America. Clinical Infectious Diseases. 2019;68(10):1777-1782. https://doi.org/10.1093/cid/ciy797
39. Al Salman J, Al Dabal L, Bassetti M, et al. Promoting cross-regional collaboration in antimicrobial stewardship: Findings of an infectious diseases working group survey in Arab countries of the Middle East. Journal of Infection and Public Health.2021;14(7):978-984. https://doi.org/10.1016/j.jiph.2021.04.009
40. Pakyz AL, Moczygemba LR, VanderWielen LM, et al. Facilitators and barriers to implementing antimicrobial stewardship strategies: results from a qualitative study. American journal of infection control. 2014;42(10):S257-263. https://doi. org/10.1016/j.ajic.2014.04.023
41. Essack S, Bell J, Shephard A. Community pharmacists—Leaders for antibiotic stewardship in respiratory tract infection. Journal
of Clinical Pharmacy and Therapeutics. 2018;43(2):302-307. https://doi.org/10.1111/jcpt.12650
42. Cappelletty D, Jacobs D. Evaluating the impact of a pharmacist’s absence from an antimicrobial stewardship team. American Journal of Health-System Pharmacy. 2013;70(12):1065-1069. https://doi.org/10.2146/ajhp120482
43. Nori P, Madaline T, Munjal I, et al. Developing interactive antimicrobial stewardship and infection prevention curricula for diverse learners: a tailored approach. InOpen Forum Infectious Diseases. 2017;4(3). https://doi.org/10.1093/ofid/ofx117