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Vol. 46. Issue 10.
Pages 549-558 (October 2022)
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Vol. 46. Issue 10.
Pages 549-558 (October 2022)
Original article
Intensivists’ perceptions and attitudes towards infectious diseases management in the ICU: An international survey
Percepciones y actitudes de los intensivistas hacia el manejo de enfermedades infecciosas en la UCI: una encuesta internacional
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A. Roshdya,b,
Corresponding author
ashraf.roshdy@nhs.net

Corresponding author.
, A.S. Elsayedc, A.S. Salehd
a Intensive Care Unit, North Middlesex University Hospital, London, UK
b Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
c Intensive Care Unit, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
d Alhayat Clinic, Edku, el-Beheira, Egypt
Article information
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Abstract
Objective

Exploring infectious diseases (ID) practice in Intensive Care Unit (ICU) to identify gaps and opportunities.

Design

Online international survey (PRACT-INF-ICU) endorsed by the ESICM and open from July 30, 2019 to October 19, 2019.

Setting

International study conducted in 78 countries.

Participants

Physicians working in ICU.

Interventions

None.

Main variables of interest

Practice variations were assessed according to respondents’ countries income class, training, and years of practice. Univariate and multivariate ordinal logistic regression were used to estimate associations between respondents’ characteristics and their perceptions regarding adequacy of training.

Results

466 intensivists with a median practice of 10 years (interquartile range, 5–19) completed the survey. A third reported no antimicrobial stewardship program and 40% had no regular microbiological rounds in their ICUs. Intensivists were mostly the decision makers for the initial antimicrobial therapy which in 70% of cases were based on guidelines or protocols. Non-ICU expertise were sought more frequently on reviewing (48/72h, culture adjustment and discontinuation in 32%, 39% and 21% respectively) rather than antimicrobial therapy initiation (16%). Only 42% described ID training as adequate. Multivariate ordinal logistic regression showed that low- to middle-income countries (OR: 0.41, 95% CI: 0.28–0.61), ICU practice ≤10 years (OR: 0.55, 95% CI: 0.39–0.79), and dual training with anaesthesia (OR: 0.52, 95% CI: 0.34–0.79) or medicine (OR: 0.49, 95% CI: 0.32–0.76) were associated with less training satisfaction.

Conclusion

ID practice is heterogeneous across ICUs while antimicrobial stewardship program is not universally implemented. From intensivists’ perspective, ID training and knowledge need improvement.

Keywords:
Antimicrobial stewardship
Antimicrobial therapy
Infection
Intensive Care Unit
Low- to middle-income countries
Survey
Infectious diseases training
Defensive medicine
Resumen
Objetivo

Explorar la práctica de enfermedades infecciosas (EI) en unidad de cuidados intensivos (UCI) para identificar lagunas y oportunidades.

Diseño

Encuesta internacional online.

ÿmbito

Estudio internacional.

Participantes

Médicos que trabajan en UCI.

Intervenciones

Ninguna.

Principales variables de interés

Las variaciones de la práctica se evaluaron de acuerdo con la clase de ingresos de los países encuestados, la formación previa y los años de práctica. Se utilizaron análisis de regresión logística ordinal para estimar las asociaciones entre las características de los encuestados y sus percepciones con respecto a la adecuación de la capacitación.

Resultados

Cuatrocientos sesenta y seis intensivistas completaron la encuesta. Un tercio de los intensivistas informó que no tenía un programa de optimización de antimicrobianos y el 40% no tenía rondas microbiológicas regulares en su UCI. Los intensivistas eran mayoritariamente los iniciadores de la terapia antibiótica inicial que en el 70% de los casos estaba basada en guías clínicas y protocolos. La regresión logística ordinal multivariante mostró que los países de ingresos bajos a medianos (OR: 0,41; IC del 95%: 0,28-0,61), práctica en la UCI ≤10 años (OR: 0,55; IC del 95%: 0,39-0,79) y entrenamiento dual con anestesiología (OR: 0,52; IC del 95%:0,34–0,79) o medicina (OR: 0,49; IC del 95%: 0,32–0,76) se asociaron con una menor satisfacción con la capacitación en EI.

Conclusiones

La práctica en EI es heterogénea en todas las UCI, mientras que el programa de optimización de antimicrobianos no se implementa universalmente. Desde la perspectiva de los intensivistas, es necesario mejorar la formación y el conocimiento en EI.

Palabras clave:
Administración de antimicrobianos
Terapia antimicrobiana
Infección
Unidad de cuidados intensivos
Países de ingresos bajos a medianos
Encuestas
Capacitación en enfermedades infecciosas
Medicina defensiva

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