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Clinicians' Knowledge, Attitudes, and Practices regarding Infections with Multidrug-Resistant Gram-Negative Bacilli in Intensive Care Units

  • Juyan Julia Zhou (a1), Sameer J. Patel (a1), Haomiao Jia (a2), Scott A. Weisenberg (a3), E. Yoko Furuya (a4) (a5), Christine J. Kubin (a4), Luis Alba (a1), Kyu Rhee (a6) and Lisa Saiman (a1) (a5)...



To assess how healthcare professionals caring for patients in intensive care units (ICUs) understand and use antimicrobial susceptibility testing (AST) for multidrug-resistant gram-negative bacilli (MDR-GNB).


A knowledge, attitude, and practice survey assessed ICU clinicians' knowledge of antimicrobial resistance, confidence interpreting AST results, and beliefs regarding the impact of AST on patient outcomes.


Sixteen ICUs affiliated with NewYork-Presbyterian Hospital.


Attending physicians and subspecialty residents with primary clinical responsibilities in adult or pediatric ICUs as well as infectious diseases subspecialists and clinical pharmacists.


Participants completed an anonymous electronic survey. Responses included 4-level Likert scales dichotomized for analysis. Multivariate analyses were performed using generalized estimating equation logistic regression to account for correlation of respondents from the same ICU.


The response rate was 51% (178 of 349 eligible participants); of the respondents, 120 (67%) were ICU physicians. Those caring for adult patients were more knowledgeable about antimicrobial activity and were more familiar with MDR-GNB infections. Only 33% and 12% of ICU physicians were familiar with standardized and specialized AST methods, respectively, but more than 95% believed that AST improved patient outcomes. After adjustment for demographic and healthcare provider characteristics, those familiar with treatment of MDR-GNB bloodstream infections, those aware of resistance mechanisms, and those aware of AST methods were more confident that they could interpret AST results and/or request additional in vitro testing.


Our study uncovered knowledge gaps and educational needs that could serve as the foundation for future interventions. Familiarity with MDR-GNB increased overall knowledge, and familiarity with AST increased confidence interpreting the results.


Corresponding author

Division of Infectious Diseases, Department of Pediatrics, Columbia University, College of Physicians and Surgeons, 650 West 168th Street, PH4 West Room 470, New York, NY 10032 (


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1. Paterson, D. Resistance in gram-negative bacteria: enterobacteriaceae. Am J Med 2006;119:S20S28.
2. Gupta, A, Delia-Latta, P, Todd, B, et al. Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails. Infect Control Hosp Epidemiol 2004;25:210215.
3. Bratu, S, Mooty, M, Nichani, S, et al. Emergence of KPC-pos-sessing Klebsiella pneumoniae in Brooklyn, New York: epidemiology and recommendations for detection. Antimicrob Agents Chemother 2005;49:30183020.
4. Siegel, J, Rhinehart, E, Jackson, M, Chiarello, L, Health Care Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Am J Infect Control 2007;35:S65S164.
5. McGowan, JE Jr. Economic impact of antimicrobial resistance. Emerg Infect Dis 2001;7:286292.
6. Kollef, MH, Sherman, G, Ward, S, Fraser, VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999;115:462474.
7. Du, B, Long, Y, Liu, H, et al. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infection: risk factors and clinical outcome. Intensive Care Med 2002;28:17181723.
8. Paterson, DL, Ko, WC, Von Gottberg, A, et al. Antibiotic therapy for Klebsiella pneumoniae bacteremia: implications of production of extended-spectrum β-lactamases. Clin Infect Dis 2004; 39:3137.
9. Wilson, SJ, Knipe, CJ, Zieger, MJ, et al. Direct costs of multidrug-resistant Acinetobacter baumannii in the burn unit of a public teaching hospital. Am f Infect Control 2004;32:342344.
10. Cabana, MD, Rand, CS, Powe, NR, et al. Why don't physicians follow clinical practice guidelines? a framework for improvement. JAMA 1999;282:14581465.
11. Cabana, MD, Ebel, BE, Cooper-Patrick, L, Powe, NR, Rubin, HR, Rand, CS. Barriers pediatricians face when using asthma practice guidelines. Arch Pediatr Adolesc Med 2000;154:685693.
12. Garber, E, Desai, M, Zhou, J, et al. Barriers to adherence to cystic fibrosis infection control guidelines. Pediatr Pulmonol 2008;43: 900907.
13. Larson, E, Quiros, D. Staff attitudes toward CDC's hand hygiene guideline. Am J Infect Control 2006;34:E128.
14. Cabana, MD, Rand, C, Slish, K, Nan, B, Davis, MM, Clark, N. Pediatrician self-efficacy for counseling parents of asthmatic children to quit smoking. Pediatrics 2004;113:7881.
15. Hardin, JW, Hilbe, JM. Generalized Estimating Equations. Boca Raton, FL: Chapman & Hall/CRC, 2003.
16. Ranji, SR, Steinman, MA, Shojania, KG, Gonzales, R. Interventions to reduce unnecessary antibiotic prescribing: a systematic review and quantitative analysis. Med Care 2008;46:847862.
17. Evans, CT, Rogers, TJ, Weaver, FM, Burns, SP. Providers' beliefs and behaviors regarding antibiotic prescribing and antibiotic resistance in persons with spinal cord injury or disorder. J Spinal Cord Med 2011;34:1621.
18. Metlay, JP, Shea, JA, Crossette, LB, Asch, DA. Tensions in antibiotic prescribing: pitting social concerns against the interests of individual patients. J Gen Intern Med 2002;17:8794.
19. Giblin, TB, Sinkowitz-Cochran, RL, Harris, PL, et al. Clinicians’ perceptions of the problem of antimicrobial resistance in health care facilities. Arch Intern Med 2004;164:16621668.
20. Sintchenko, V, Iredell, JR, Gilbert, GL, Coiera, E. What do physicians think about evidence-based antibiotic use in critical care? a survey of Australian intensivists and infectious disease practitioners. Intern Med J 2001;31:462469.
21. Guerra, CM, Pereira, CA, Neves Neto, AR, Cardo, DM, Correa, L. Physicians’ perceptions, beliefs, attitudes, and knowledge concerning antimicrobial resistance in a Brazilian teaching hospital. Infect Control Hosp Epidemiol 2007;28:14111414.
22. Srinivasan, A, Song, X, Richards, A, Sinkowitz-Cochran, R, Cardo, D, Rand, C. A survey of knowledge, attitudes, and beliefs of house staff physicians from various specialties concerning antimicrobial use and resistance. Arch Intern Med 2004;164:14511456.
23. Minen, MT, Duquaine, D, Marx, MA, Weiss, D. A survey of knowledge, attitudes, and beliefs of medical students concerning antimicrobial use and resistance. Microb Drug Resist 2010;16:285289.
24. Wester, CW, Durairaj, L, Evans, AT, Schwartz, DN, Husain, S, Martinez, E. Antibiotic resistance: a survey of physician perceptions. Arch Intern Med 2002;162:22102216.
25. Pulcini, C, Williams, F, Molinari, N, Davey, P, Nathwani, D. Junior doctors’ knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland. Clin Microbiol Infect 2011;17:8087.
26. Quale, J, Bratu, S, Landman, D, Heddurshetti, R. Molecular epidemiology and mechanisms of carbapenem resistance in Aci-netobacter baumannii endemic in New York City. Clin Infect Dis 2003;37:214220.
27. Quale, JM, Landman, D, Bradford, PA, et al. Molecular epidemiology of a citywide outbreak of extended-spectrum β-lacta-mase-producing Klebsiella pneumoniae infection. Clin Infect Dis 2002;35:834841.
28. Patel, S, Landers, T, Larson, E, et al. Clinical vignettes provide an understanding of antibiotic prescribing practices in neonatal intensive care units. Infect Control Hosp Epidemiol 2011;32:597602.
29. Dellit, TH, Owens, RC, McGowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44: 159177.

Clinicians' Knowledge, Attitudes, and Practices regarding Infections with Multidrug-Resistant Gram-Negative Bacilli in Intensive Care Units

  • Juyan Julia Zhou (a1), Sameer J. Patel (a1), Haomiao Jia (a2), Scott A. Weisenberg (a3), E. Yoko Furuya (a4) (a5), Christine J. Kubin (a4), Luis Alba (a1), Kyu Rhee (a6) and Lisa Saiman (a1) (a5)...


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