Whose job is it to reduce the rise of superbugs? Clinicians can’t agree

Australia’s doctors, dentists and veterinarians can’t agree whose job it is to reduce the rise of antimicrobial resistance, a first-ever survey reveals.

The investigation of 1330 doctors, dentists and veterinarians was broadly representative of each national workforce and identified many common and context-specific barriers to better prescribing practices by clinicians.

Antimicrobial resistance has developed through the overuse and misuse of antibiotics so that bacterial infections that were once easily cured with antibiotics are becoming harder to treat.

It threatens the effective prevention and treatment of an increasing range of infections caused by bacteria, parasites, viruses and fungi.

In 2014, nearly half of all Australians were prescribed antimicrobials and the threat of antimicrobial resistance has the potential to affect every individual.

“There was agreement across prescriber groups that joint action on antimicrobial resistance is needed but they tend to see the role of others as having a greater responsibility,” says Professor Dale Dominey Howes of the University of Sydney, who led the research with the University of Technology Sydney (UTS).

“On the plus side, prescribers are quite knowledgeable about antimicrobial resistance and are aware of its connections between human, animal and environmental ecosystems.”

For example, factors rated as “somewhat” of a barrier that were common across professions included:

• lack of patient understanding about antibiotics
• fear of blame for failure to prescribe if antibiotics were later proven to be necessary
• difficulty of making an accurate diagnosis
• lack of clear guidelines for some conditions
• and fear of missing an infection.

“These common barriers indicate broader challenges across professions and settings,” says UTS co-author Associate Professor Maurizio Labbate.

“These highlight the need for greater public awareness of antimicrobial resistance and a need to reduce diagnostic uncertainty by developing faster and more accessible diagnostic tests to limit the need for risk-averse strategies such as prescribing unnecessarily, or ‘just in case’.”

Key findings

• All prescriber groups rated antimicrobial resistance as a “significant” problem to the health of patients in human hospitals and residents in nursing homes and aged-care facilities
• All groups reported that patients’ clinical signs and symptoms strongly influenced their prescribing decisions. For example, patients described as critically ill or immunocompromised were rated as a “strong influence” among all groups, especially doctors
• Bacterial culture and susceptibility test results were rated as a “strong influence” on doctors’ and veterinarians’ decisions to prescribe antibiotics or not, and as exerting “no influence” or being “not applicable” among dentists
• Doctors were generally more aware than dentists or veterinarians that a single course of antibiotics could lead to resistance and that resistant bacteria may persist for up to year in a patient after a single use of antibiotics
• Contrary to existing research findings and despite respondents perceiving public education as a “very helpful” measure in supporting appropriate prescribing, respondents did not consider commonly reported barriers such as patient/client pressure and expectations as having a “significant” influence on their prescribing behaviours.

The results of the survey are published in BMJ Open.