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Patient Attitudes Regarding Participation in Studies of Antimicrobial Resistance

  • Pam Tolomeo (a1), Mary Wheeler (a1) (a2), Joshua P. Metlay (a1) (a3) (a4) (a5) (a6), Katrina Armstrong (a1) (a4) (a5), Neil O. Fishman (a3) (a7), Warren B. Bilker (a1) (a3) (a5) and Ebbing Lautenbach (a1) (a3) (a7) (a5)...



A number of recent studies of antimicrobial resistance have focused on the role of antimicrobial-resistant pathogens that colonize the gastrointestinal tract. However, participation rates have been low in studies that involve fecal sampling. Attitudes toward such studies among potential study participants have not been assessed.


We conducted a cross-sectional survey, enrolling 3 groups of inpatients from a large academic center. Group 1 consisted of patients who had previously participated in a cohort study of fluoroquinolone-resistant Escherichia coli, which involved the collection of perirectal swab samples. Group 2 consisted of patients who had previously refused to participate in the study of fluoroquinolone-resistant E. coli. Group 3 consisted of patients who had never been asked to participate in the study of the fluoroquinolone-resistant E. coli. The survey assessed patients' attitudes and beliefs regarding medical research and their willingness to consent to collection of a perirectal swab sample. Response options were recorded on a 5-point Likert scale. The Fisher exact test was used to compare dichotomized responses across study groups.


A total of 90 patients were surveyed: there were 29 in group 1 and in group 2 and 32 in group 3. Of 90 patients, 31 (35%) believed researchers might run additional tests on collected samples without informing the patient, whereas 25 (27%) believed persons other than the research team might gain access to study results. The belief that a person could get sicker as a result of a having a perirectal swab sample collected was significantly more common among patients who had previously refused to participate in the fluoroquinolone-resistant E. coli study.


This study highlights important beliefs and attitudes that are associated with the likelihood of participating in studies of antimicrobial resistance. Explicitly addressing these concerns with eligible patients is critical to optimize participation in future studies.


Corresponding author

Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 825 Blockley Hall, 423 Guardian Dr., Philadelphia, PA 19104-6021 (


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