Download A Survey amongst the German General Population

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.