Comments by Microbiologists for Interpreting Antimicrobial Susceptibility Testing and Improving the Appropriateness of Antibiotic Therapy in Community-Acquired Urinary Tract Infections: A Randomized Double-Blind Digital Case-Vignette Controlled Superiority Trial
Abstract
:1. Introduction
2. Results
2.1. Attitudes toward Antimicrobial Susceptibility Testing
2.2. Empirical Antibiotic Therapy
2.3. Targeted Antibiotic Therapy, Primary Outcome
2.4. Deviation from First-Line Antibiotic Regimen, Secondary Outcome
2.5. Use of Broad-Spectrum Antibiotics, Secondary Outcome
3. Discussion
4. Materials and Methods
4.1. Design, Participants, and Data Collection
4.2. Self-Questionnaire
4.3. Comments, i.e., the Intervention
4.4. Outcomes
4.5. Statistical Analysis
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Control (N = 424) | Intervention (N = 391) | Total (N = 815) | |
---|---|---|---|
Sex | N = 812 | ||
Women | 280 (66.5%) | 245 (62.7%) | 525 (64.7%) |
Men | 141 (33.5%) | 146 (37.3%) | 287 (35.3%) |
Age | N = 815 | ||
Mean ± SD | 37.1 ± 11.6 | 36.7 ± 11.2 | 36.9 ± 11.4 |
Median (Q1–Q3) | 33.0 (29.0–42.0) | 33.0 (29.0–39.5) | 33.0 (29.0–41.0) |
Min–max | 23.0–73.0 | 24.0–74.0 | 23.0–74.0 |
Professional status of GPs * | N = 815 | ||
Established | 258 (60.8%) | 237 (60.6%) | 495 (60.7%) |
Replacing other GPs | 53 (12.5%) | 54 (13.8%) | 107 (13.1%) |
Resident | 113 (26.7%) | 100 (25.6%) | 213 (26.2%) |
Professional experience | N = 815 | ||
Mean ± SD | 11.7 ± 11.8 | 10.6 ± 11.3 | 11.2 ± 11.6 |
Median (Q1–Q3) | 7.00 (3.00–19.0) | 6.00 (3.00–16.0) | 6.00 (3.00–17.0) |
Min–max | 0–48.0 | 0–46.0 | 0–48.0 |
Working environment | N = 814 | ||
Urban | 156 (36.9%) | 148 (37.9%) | 304 (37.3%) |
Semi-rural | 208 (49.2%) | 187 (47.8%) | 395 (48.5%) |
Rural | 59 (13.9%) | 56 (14.3%) | 115 (14.1%) |
Main mode of practice | N = 815 | ||
At hospital/healthcare facility | 41 (9.67%) | 32 (8.18%) | 73 (8.96%) |
In group practices | 330 (77.8%) | 318 (81.3%) | 648 (79.5%) |
Alone | 53 (12.5%) | 41 (10.5%) | 94 (11.5%) |
Student mentoring | N = 815 | ||
Yes | 104 (24.5%) | 82 (21.0%) | 186 (22.8%) |
No | 320 (75.5%) | 309 (79.0%) | 629 (77.2%) |
Control (N = 424) | Intervention (N = 391) | Total (N = 815) | |
---|---|---|---|
Attitude toward AST * interpretation | |||
At ease to interpret; willing to be trained | 135 (31.8%) | 112 (28.7%) | 247 (30.3%) |
At ease to interpret; not willing to be trained | 274 (64.6%) | 269 (68.9%) | 543 (66.6%) |
Not at ease to interpret; willing to be trained | 12 (2.8%) | 9 (2.3%) | 21 (2.7%) |
Not at ease to interpret; not willing to be trained | 3 (0.8%) | 1 (0.1%) | 4 (0.4%) |
CDSS † use for prescribing antibiotics in UTIs ‡ | |||
Yes | 383 (90.3%) | 351 (89.8%) | 734 (90.1%) |
No | 41 (9.67%) | 40 (10.2%) | 81 (9.94%) |
Seek advice from an infectious disease specialist for management of UTIs ‡ | |||
Frequently | 5 (1.18%) | 4 (1.02%) | 9 (1.10%) |
Occasionally | 87 (20.5%) | 69 (17.6%) | 156 (19.1%) |
Rarely | 247 (58.3%) | 225 (57.5%) | 472 (57.9%) |
Never | 85 (20.0%) | 93 (23.8%) | 178 (21.8%) |
Variable | N | OR * | 95% CI | p-Value |
---|---|---|---|---|
Sex | ||||
Women | 452 | Ref. | ||
Man | 258 | 1.12 | 0.71–1.78 | 0.600 |
Age (categories) | ||||
23 to 34 years-old | 425 | Ref. | ||
35 to 74 years-old | 285 | 0.91 | 0.42–1.91 | 0.800 |
Main mode of practice | ||||
In primary care | 646 | Ref. | ||
In healthcare facilities | 64 | 2.38 | 1.02–6.16 | 0.046 |
Professional experience | ||||
>5 years | 319 | Ref. | ||
≤5 years | 200 | 0.71 | 0.32–1.53 | 0.400 |
Resident | 191 | 0.82 | 0.34–1.92 | 0.600 |
Student mentoring | ||||
Yes | 167 | Ref. | ||
No | 543 | 1.08 | 0.63–1.84 | 0.800 |
CDSS † use for antibiotic prescribing | ||||
Yes | 643 | Ref. | ||
No | 37 | 0.76 | 0.36–1.69 | 0.500 |
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Piet, E.; N’Diaye, Y.; Marzani, J.; Pires, L.; Petitprez, H.; Delory, T. Comments by Microbiologists for Interpreting Antimicrobial Susceptibility Testing and Improving the Appropriateness of Antibiotic Therapy in Community-Acquired Urinary Tract Infections: A Randomized Double-Blind Digital Case-Vignette Controlled Superiority Trial. Antibiotics 2023, 12, 1272. https://doi.org/10.3390/antibiotics12081272
Piet E, N’Diaye Y, Marzani J, Pires L, Petitprez H, Delory T. Comments by Microbiologists for Interpreting Antimicrobial Susceptibility Testing and Improving the Appropriateness of Antibiotic Therapy in Community-Acquired Urinary Tract Infections: A Randomized Double-Blind Digital Case-Vignette Controlled Superiority Trial. Antibiotics. 2023; 12(8):1272. https://doi.org/10.3390/antibiotics12081272
Chicago/Turabian StylePiet, Emilie, Youssoupha N’Diaye, Johann Marzani, Lucas Pires, Hélène Petitprez, and Tristan Delory. 2023. "Comments by Microbiologists for Interpreting Antimicrobial Susceptibility Testing and Improving the Appropriateness of Antibiotic Therapy in Community-Acquired Urinary Tract Infections: A Randomized Double-Blind Digital Case-Vignette Controlled Superiority Trial" Antibiotics 12, no. 8: 1272. https://doi.org/10.3390/antibiotics12081272
APA StylePiet, E., N’Diaye, Y., Marzani, J., Pires, L., Petitprez, H., & Delory, T. (2023). Comments by Microbiologists for Interpreting Antimicrobial Susceptibility Testing and Improving the Appropriateness of Antibiotic Therapy in Community-Acquired Urinary Tract Infections: A Randomized Double-Blind Digital Case-Vignette Controlled Superiority Trial. Antibiotics, 12(8), 1272. https://doi.org/10.3390/antibiotics12081272