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Antimicrobial Drugs and Resistance: A Survey amongst the German General Population Sandra Schneider 1, Florian Salm 1, Christin Schröder 1, Norman Ludwig 2, Regina Hanke 1,2, Petra Gastmeier 1 1Institut für Hygiene und Umweltmedizin, Charité Universitätsmedizin Berlin; 2Lindgrün GmbH, Berlin Introduction Objective Selection and transmission of multidrug resistant organisms (MDRO) are complex issues involving hospitals, ambulatory care, travel, livestock, pets and more. So far, antibiotic (AB) stewardship approaches have usually been focusing on one small segment. RAI (Rationaler Antibiotikaeinsatz durch Information und Kommunikation) is an eastern German network project of veterinarians, primary care physicians, clinicians, infection control specialists as well as communication and design experts tackling the problem from multiple perspectives and developing a multifaceted information and communication intervention concerning AB usage and resistance. The first project phase is dealing with evaluation of barriers and specification of target groups. Therefore, multiple qualitative and quantitative analyses are performed. Amongst others, the German general population was addressed. Methods Table 1: Questionaire for telephone-based interviews Nr. Target group Original question Englisch translation Answer mode Q1 All (n = 1004) Was glauben Sie, wer oder was kann gegen ein Antibiotikum resistent werden? What do you think, who or what gets restistant towards antibiotic drugs? Single choice Q2 All (n = 1004) Wie wichtig ist das Thema Antibiotikaresistenzen für Sie? How important is the issue of antibiotic resistance for you? Single choice Do you think, that your own behaviour concerning antibiotic drugs does have an influence on developement of antibiotic resistance? Single choice Glauben Sie, dass Ihr eigenes Verhalten im Persons, who know the expression Umgang mit Antibiotika Einfluss auf die Q3 „antibiotic resistance“ (n = 991) allgemeine Entwicklung von Antibiotikaresistenzen hat? In welchen Bereichen sollte man Ihrer Meinung Where do you see a focus for stopping the Persons, who know the expression nach in erster Linie ansetzen, um die Zunahme increasing developement of antibiotic Q4 „antibiotic resistance“ (n = 991) von Antibiotikaresistenzen einzudämmen? resistance? Q5 All (n = 1004) Multiple choice Waren Sie im letzten Jahr mit einem Infekt beim Have you seen a physician because of an Arzt? infection during the last year? Single choice Q6 Persons, who answered Q5 with „yes“ (n = 375) Hat der Arzt dabei mit Ihnen über das Thema Antibiotikaresistenzen gesprochen? Did the physician talk with you about antibiotic resistance? Single choice Q7 Persons, who answered Q5 with „yes“ (n = 375) Wurde Ihnen wegen des Infekts ein Antibiotikum verordnet? Did your physician prescribe an antibiotic for the infection? Single choice Q8 All (n = 1004) Haben Sie schon mal ein Antibiotikum ohne ärztliche Verordnung eingenommen? Did you ever take an antibiotic without prescription? Multiple choice Q9 All (n = 1004) Kennen Sie persönlich Menschen, die Probleme Do you personally know people suffering from mit multiresistenten Erregern haben? problems with MDRO? Multiple choice To get insights into knowledge, experience and behavior of German Non-Prescribors concerning AB drug use and MDRO. The first project phase is dealing with evaluation of barriers and specification of target groups. Therefore, multiple qualitative and quantitative analyses are performed. Amongst others, the German general population was addressed. A telephone-based survey was conducted via TNS Emnid. A sample of 1004 persons, representative for the German population, was surveyed. General sociodemographic data were included and weighted. The questions addressed various aspects of MDRO and AB drug intake in a nine item questionnaire. Univariable and multivariable risk factor analyses were performed based on Chi-Square tests and Logistic regression models. Table 2: List of co-variables used in multivariable analyses Gender Age Region (east / west) Size of borough (village, small city, large city, metropol) Education status Number of persons in the household Income Working status Knowledge (variable created from Q1) Personal link to MRDO (variable created from Q9) Results Don't know 7% Answers: „Yes“: 37% „No“: 58% „Don‘t know“: 5% No answer 1% Men 20% Viruses and bacteria 37% Viruses 11% Bacteria 24% not important at all 8% #* Question 1 - Knowledge: Distribution of answers given to Q1. Significant influence factors in the multivariable analysis were education status and number of persons in the household. How important is the issue of antibiotic resistance for you? very important 41% rather not important 18% yes 37% Where do you see a focus for stopping the increasing developement of antibiotic resistance? hospital hygiene 66 antibiotic prescriptions by general practitioners Significant influence factors in the multivariable analysis were gender (OR for choosing “very or rather important” = 1,9) and personal link to MDRO (OR = 1,9) Summary / Conclusion Did the physician prescribe an antibiotic for the infection? yes 20% yes 59% 75 patients received information 221 patients received an antibiotic Question 5, 6, 7 – Communication and antibiotic prescription practice from the patients view 57 antibiotic use in animal farming 53 42 antibiotic drug intake by the patient Question 2 – Relevance: Distribution of answers given to Q2. #: 1% die not know the expression “antibiotic resistance”; *: 2% answered: “don’t know”; Did the physician talk with you about antibiotic resistance? Question 3 - Self efficacy: Significant influence factors in the multivariable analysis to choose the answer “yes” were coming from west Germany, giving income informations and knowing persons with MDRO problems. antibiotic use in hospitals rather important 30% Have you seen a physician because of an infection during the last year? Do you think, that your own behaviour concerning antibiotic drugs does have an influence on developement of antibiotic resistance? 32 no answer 1 don't know 1 nothing of these 1 Percentage of answers (multiple choice) Question 4 – Responsibility: : Distribution of answers ordered by frequency. Did you ever take an antibiotic without prescription? Frequency of answer yes in % What do you think, who or what gets restistant towards antibiotic drugs? 100 90 Answers all: Yes: 8% 80 70 60 50 40 30 20 10 17 0 Age < 30 13 7 1 3 30 plus 40 plus 50 plus 60 plus Question 8 – Self intake of antibiotics: Distribution by age. Whereas nearly all people know the expression of AB resistance and the issue is relevant to many of them, knowledge about development of MDRO is sparse. The own influence on MDRO development is judged higher in west than in east Germany. Hospital hygiene is seen as the main factor for driving resistance. 3-fold more patients get antibiotics than information on AB resistance when treated by a physician due to infection. Surprisingly many people have been taking AB without prescription, especially in the young generation. Hence, this survey highlights intervention points on both sides – physician and patient.