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294 Physicians' Knowledge, Attitudes, and Practices regarding Multidrug-Resistant Gram-Negative Bacilli (MDR-GNB) in Intensive Care Units (ICUs)

Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Juyan Julia Zhou, MS, MPH , Columbia University, New York, NY
Sameer J. Patel, MD , Columbia University, New York, NY
Scott Weisenberg, MD, DTM&H , Weill Cornell Medical College; NewYork-Presbyterian Hospital, New York, NY
E. Yoko Furuya, MD, MS , Columbia University; NewYork-Presbyterian Hospital, New York, NY
Christine J. Kubin, PharmD , Columbia University; NewYork-Presbyterian Hospital, New York, NY
Luis Alba, BS , Columbia University, New York, NY
Haomiao Jia, PhD , Columbia University, New York, NY
Kyu Rhee, MD, PhD , Weill Cornell Medical College; NewYork-Presbyterian Hospital, New York, NY
Lisa Saiman, MD, MPH , Columbia University; NewYork-Presbyterian Hospital, New York, NY
Background:

An improved understanding of the educational needs of ICU physicians could enhance prevention and management of MDR-GNB.

Objective:

We surveyed the knowledge, attitudes and practices of ICU physicians regarding MDR-GNB and compared differences in responses between different groups of providers.

Methods:

ICU attending physicians and fellows from 16 adult and pediatric ICUs at NewYork-Presbyterian (NYP) Hospital were asked to complete an anonymous electronic survey.  Responses included 4-level Likert scales which were dichotomized for analysis.

Results:

Of 256 eligible participants, 47% completed the survey including 55 pediatric and 65 adult ICU physicians. The majority agreed that MDR-GNB were a serious problem nationally (98%) and at NYP (96%). About half reported they were very familiar with treatment of MDR-GNB infections, although adult providers were generally more familiar with these infections than pediatric providers. The majority (97%) agreed that limiting broad spectrum agents could decrease resistance, but fewer (74%) agreed that contact precautions could decrease resistance. The survey identified knowledge deficits. Only 56% were aware of the MDR-GNB case definition for contact precautions at NYP. Respondents answered incorrectly (23%) or were ‘not sure’ (38%) about the activity of specific antimicrobial agents (e.g., tigecycline, carbapenems), although adult providers had more correct answers than pediatric providers. Respondents felt that in vitro susceptibility testing (95%), infectious diseases (ID) consults (92%), and pre-approval for restricted antibiotics (83%) could improve patient outcomes. However, most were not confident they could interpret in vitro susceptibility testing results (59%) or use local resistance patterns (54%) to guide MDR-GNB treatment, although adult ICU physicians were more confident than pediatric ICU physicians (p<0.05). ID consults (91%) and NYP web-based resources (90%) were ranked as the most important resources for guiding antimicrobial management. Fellows ranked literature searches, lectures, and electronic prescribing guidelines as more important than attending physicians did (p<0.05).

Conclusions:

We identified several gaps in knowledge and/or lack of confidence in performing certain practices that could impede prevention and management of MDR-GNB. Adult providers had more knowledge and familiarity with MDR-GNB than pediatric providers. These findings can guide future interventions.