Veterinary Medical Students’ Perceptions, Attitude and Knowledge about Antibiotic Resistance and Stewardship: How Prepared Are Our Future Prescribers?

  • Madubuike Umunna ANYANWU University of Nigeria, Microbiology Unit, Department of Veterinary Pathology and Microbiology, Nsukka (NG)
  • Onyinye Jane OKORIE-KANU University of Nigeria, Department of Public Health and Preventive Medicine, Nsukka (NG)
  • Chidiebere Ohazuruike ANYAOHA University of Nigeria, Department of Public Health and Preventive Medicine, Nsukka (NG)
  • Oluwatosin Ajoke KOLADE University of Nigeria, Veterinary Teaching Hospital, Nsukka (NG)
Keywords: antibiotic resistance; antibiotic stewardship; education; veterinary medical students

Abstract

A cross sectional, multicentre survey utilizing a questionnaire was used to assess 6th- (final-) year veterinary medical students’ perceptions, attitude and knowledge about antibiotic resistance (ABR) and stewardship (ABS) in 5 conveniently-selected veterinary schools in Nigeria. Data obtained were analyzed by Fischer’s exact and χ2 tests at a significance level of P < 0.05. Out of 175 final-year veterinary students, 95 (54.3% i.e., response rate) completed the survey. Of the 95, 17% have heard about ABS and 7% knew the meaning of ABS. Less than 10% knew the core principles and goals of ABS and less than 20% of the respondents knew the ideal members of an ABS team. All the respondents rightly knew that no antibiotic stewardship programme (ASP) exist in veterinary hospitals in Nigeria, nearly all of them (97%) reported that antibiograms are rarely used during antibiotic (AB) prescription in their institutional veterinary teaching hospital (VTH) and about two-third (65%) believed that ABs are overused in most veterinary hospitals in Nigeria. Most of the respondents believed that ABR is of greater concern at national level than in their institutional VTHs and majority of them (92%) believed that ABR is a global problem (P = 0.009). Minority of the respondents knew that inadequate personal hygiene, use of substandard ABs, prescription of ABs by non-veterinarians/professionals, poor infection control practices, treating self-limiting infections with ABs, suboptimal and incomplete AB doses (P = 0.017), are factors that promote ABR. Minority of the respondents knew that education on AB therapy (44%), development of antibiotic usage policies (35%), reduction of AB use (14%), establishment of national AB resistance surveillance (28%) and development of institutional guidelines for AB use (29%), are critical interventions to curb ABR. Only 17% of the respondents felt that their education on ABR is adequate for their veterinary career. Most of the respondents believed that strong knowledge of ABs is important for their future veterinary career and would like more education about ABR and ABS. Overall mean correct score of 29% on clinical knowledge vignettes with similar scores across the schools in all the areas, was recorded. This survey has shown that Nigerian veterinary students’ perception and knowledge about ABR and ABS are poor and therefore creates doubt about their preparedness to practice ABS. There is urgent need for improved ABS education in Nigerian veterinary schools.

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References

Abbo LM, Cosgrove SE, Pottinger PS, Pereyra M, Sinkowitz-Cochran R, Srinivasan A, ... Hooton TM (2013). Medical students’ perceptions and knowledge about antimicrobial stewardship: How are we educating our future prescribers? Clinical Infectious Diseases 57(5):631-638.

Abera B, Kibret M, Mulu W (2014). Knowledge and beliefs on antimicrobial resistance among physicians and nurses in hospitals in Amhara Region, Ethiopia. BMC Pharmacology and Toxicology 15:26.

Afzal Khan AK, Banu G, Rehma KK (2013). Antibiotic resistance and usage- a survey on the knowledge, attitude, perceptions and practices among the medical students of a southern Indian teaching hospital. Journal of Clinical Diagnostic Research 7:1613-1616.

Anyanwu MU, Kolade OA (2017). Veterinarians’ perception, knowledge and practices of antibiotic stewardship in Enugu State Southeast, Nigeria. Notulae Scientia Biologicae 9(3):321-331.

Beerlage-De Jong N, Gemert-Pijnen L, Wentzel J, Hendrix R, Siemons L (2017). Technology to support integrated antimicrobial stewardship programs: a user centred and stakeholder riven development approach. Infectious Disease Reports 9:6829.

Bowater L (2015). Antimicrobial stewardship: the role of scientists? Journal of Antimicrobial Chemotherapy 70:1925-1927.

Brink A, Shoeman J, Muntingh G (2017). Undergraduate antibiotic stewardship training: are we leaving our future prescribers flapping in wind? South African Medical Journal 107(5):357-358.

Broom J, Broom A, Adams K, Plage S (2016). What prevents the intravenous to oral antibiotic switch? A qualitative study of hospital doctors’ accounts of what influences their clinical practice. Journal of Antimicrobial Chemotherapy 71:2295-2299.

Burger M, Fouriea J, Lootsa D, Mnisia T, Schellacka N, Bezuidenhouta S, Meyera JC (2016). Knowledge and perceptions of antimicrobial stewardship concepts among final year pharmacy students in pharmacy schools across South Africa. South African Journal of Infectious Diseases 31(3):84-90.

Castro-Sánchez E, Drumright LN, Gharbi M, Farrell S, Holmes AH (2016). Mapping antimicrobial stewardship in undergraduate medical, dental, pharmacy, nursing and veterinary education in the United Kingdom. PLoS ONE 11:doi:10.1371 /journal.pone.0150056.

Chaves NJ, Cheng AC, Runnegar N, Kirschner J, Lee T, Buising K (2014). Analysis of knowledge and attitude surveys to identify barriers and enablers of appropriate antimicrobial prescribing in three Australian tertiary hospitals. Internal Medicine Journal 44:568-574.

Cisneros JM, Neth O, Gil-Navarro MV, Lepe JA, Jimenez-Parrilla F, Cordero E, ...PRIOAM Team (2014). Global impact of an educational antimicrobial stewardship programme on prescribing practice in a tertiary hospital centre. Clinical Microbiology and Infection 20(1):82-88.

Coates ARM, Halls G, Hu Y (2011). Novel classes of antibiotics or more of the same? British Journal of Pharmacology 163:184-194.

Cotta MO, Robertson MS, Tacey M, Marshall C, Thursky KA, Liew D (2014). Attitudes towards antimicrobial stewardship: results from a large private hospital in Australia. Healthcare Infection 19(3):89-94.

Coyne LA, Latham SM, Williams NJ, Dawson S, Donald IJ, Pearson RB, Smith RF, Pinchbeck GL (2016). Understanding the culture of antimicrobial prescribing in agriculture: a qualitative study of UK pig veterinary surgeons. Journal of Antimicrobial Chemotherapy 71:3300-3312.

Dellit TH, Owens RC, Mcgowan JE Jr, Gerding DN, Weinstein RA, Burke JP, ... Hooton TM, Infectious Diseases Society Of America, Society For Healthcare Epidemiology Of America (2007). Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clinical Infectious Diseases 44(2):159-177.

Dyar OJ, Hills H, Seitz LT, Perry A, Ashiru-Oredope D (2018). Assessing the knowledge, attitudes and behavior of human and animal health students towards antibiotic use and resistance: a pilot cross-sectional study in the UK. Antibiotics 7(10) doi:10.3390/antibiotics7010010.

Dyar OJ, Pulcini C, Howard P, Nathwani D, ESGAP (ESCMID Study Group for Antibiotic Policies) (2014). European medical students: a first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. Journal of Antimicrobial Chemotherapy 69:842-846.

Espinosa-Gongora C, Dyar O, Beovic B, Bousquet-Melou A, Gonzalez-Zorn B, Jessen LR, ... Guardabassi L (2017). Towards a comprehensive education and training of European veterinary students in antimicrobial stewardship. 27th ECCMID Congress Vienna 2017.

Essack SY, Desta AT, Abostsi RE, Agoba EE (2017). Antimicrobial resistance in the WHO African region: current status and roadmap for action. Journal of Public Health 39(1):8-13.

Eyal L, Cohen R (2006). Preparation for clinical practice: A survey of medical students’ and graduates’ perceptions of the effectiveness of their medical school curriculum. Medical Teacher 28:e162-e170.

Fairles J (2013). The veterinarian’s role in antimicrobial stewardship. Canadian Veterinary Journal 54(3):207-210.

Ferdoush J, Ata M, Parveen K, Reza FH, Rahman MS (2016). Knowledge, perception and preparedness of future prescribers about antimicrobial stewardship. Bangladesh Journal of Pharmacology 11(4):928-934.

Fitchett JR, Atun R (2016). Antimicrobial resistance: Opportunity for Europe to establish global leadership. Lancet Infectious Diseases 16:388-389.

Friedman ND, Temkin E, Carmeli Y (2016). The negative impact of antibiotic resistance. Clinical Microbiology and Infection 22(5):416-422.

Garcia C, Llamoca LP, Garcia K, Jimenez A, Samalvides F, Gotuzzo E, Jacobs J (2011). Knowledge, attitudes and practice survey about antimicrobial resistance and prescribing among physicians in hospital setting in Lima Peru. BMC Clinical Pharmacology 11:8.

Gharbi M, Moore LSP, Castro-Sánchez E, Spanoudaki E, Grady C, Holmes AH, Drumright L (2016). A needs assessment study for optimising prescribing practice in secondary care junior doctors: the antibiotic prescribing education among doctors (APED). BMC Infectious Diseases 16:456.

Gross R, Morgan AS, Kinky DE, Weiner M, Gibson GA, Fishman NO (2001). Impact of a hospital based antimicrobial management program on clinical and economic outcomes. Clinical Infectious Diseases 33:289-295.

Guardabassi L, Prescott JF (2015). Antimicrobial stewardship in small animal veterinary practice: from theory to practice. Veterinary Clinics of North America: Small Animal Practice 45:361-376.

Haque M, Rahman NIA, Zulkifli Z, Ismail S (2016). Antibiotic prescribing and resistance: knowledge level of medical students of clinical years of University Sultan Zainal Abidin, Malaysia. Therapeutics and Clinical Risk Management 12:413-426.

Harakeh S, Almatrafi M, Ungapen H, Hammad R, Olayan F, Hakim R, Ayoub M, ... Cals JW (2015). Perceptions of medical students towards antibiotic prescribing for upper respiratory tract infections in Saudi Arabia. BMJ Open Respiratory Research 23: e000078.

Hoque R, Mostafa A, Haque M (2016). Insight of medical students of clinical years to antimicrobials prescribing and resistance in private medical school, Chittagong, Bangladesh. Journal of Young Pharmacists 8(4):447-455.

Johnson TP, Wislar JS (2012). Response rates and nonresponse errors in surveys. JAMA 307:1805-1806.

Justo JN, Gauthier TP, Scheetz MH, Chahine EB, Bookstaver PB, Gallagher JC, ... MacDougall C (2014). Knowledge and attitudes of Doctor of Pharmacy students regarding the appropriate use of antimicrobials. Clinical Infectious Diseases 59(Suppl 3):S162-S169.

Keessen EC, Gaastra W, Lipman LJ (2011). Clostridium difficile infection in humans and animals, differences and similarities. Veterinary Microbiology 153:205-217.

Khan MU, Hassali MAA, Ahmad A, Elkalmi RM, Zaidi STR, Dhingra S (2016). Perceptions and practices of community pharmacists towards antimicrobial stewardship in the state of Selangor, Malaysia. PLoS ONE 11:e0149623.

Khan Y, Boschmans S-A, McCartney J (2017). Undergraduate antimicrobial stewardship training for pharmacy students: creating a foundation for containment of antimicrobial resistance in South Africa. South African Medical Journal 107(9):722.

Lanza VF, Baquero F, Martinez L, Ramos-Ruíz R, González-Zorn B, Andremont A, ... Coque TM (2018). In-depth resistome analysis by targeted metagenomics. Microbiome 6:11.

Lee C-R, Lee JH, Kang L-W, Jeong BC, Lee SH (2015). Educational effectiveness, target, and content for prudent antibiotic use. Biomed Research International http://dx.doi.org/10.1155/2015/214021

Llor C, Bjerrum L (2014). Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Therapeutic Advances in Drug Safety 5(6):229-241.

Luther VP, Ohl CA, Hicks LA (2013). Antimicrobial stewardship education for medical students. Clinical Infectious Diseases 57(9):1366.

MacDougall C, Schwartz BS, Kim L, Nanamori M, Shekarchian S, Chin-Hong PV (2017). An interprofessional curriculum on antimicrobial stewardship improves knowledge and attitudes toward appropriate antimicrobial use and collaboration. Open Forum Infectious Diseases 4:ofw225.

MacDougall C, Polk RE (2005). Antimicrobial stewardship programs in health care systems. Clinical Microbiology Reviews 18:638-656.

Maurer FP, Christner M, Hentschke M, Rhode H (2017). Advances in rapid identification and susceptibility testing of bacteria in clinical Microbiology laboratory: implications for patient outcome and antimicrobial stewardship program. Infectious Disease Reports 9:6839.

Minen MT, Duquaine D, Marx MA, Weiss D (2010). A survey of knowledge, attitudes, and beliefs of medical students concerning antimicrobial use and resistance. Microbial Drug Resistance 16(4):285-289.

Moran D (2017). Antimicrobial resistance in animal agriculture: understanding user attitude and behaviours. Veterinary Record 181(19):508-509.

Nordmann P, Jayol A, Poirel L (2016). Rapid detection of polymyxin resistance in Enterobacteriaceae. Emerging Infectious Diseases 22:1038-1043.

Nori P, Madaline T, Munjal I, Bhar S, Guo Y, Seo SK, ... Ostrowsky B (2017). Developing interactive antimicrobial stewardship and infection prevention curricula for diverse learners: A tailored approach. Open Forum Infectious Diseases 10.1093/ofid/ofx117.

O’Donnell LA, Guarascio AJ (2017). The intersection of antimicrobial stewardship and microbiology: educating the next generation of health care professionals. Frontiers in Microbiology Letters 364:fnw281.

O’Neill J (2014). Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Review on antimicrobial resistance. http://amr-review.org/Publications.

Oberje EJM, Tanke MAC, Jeurissen PPT (2017). Antimicrobial stewardship initiatives throughout Europe: proven value for money. Infectious Disease Reports 9:6800.

Ohl CA, Luther VP (2014). Health care provider education as a tool to enhance antibiotic stewardship practices. Infectious Disease Clinics of North America 28:177-193.

Okeke IN, Peeling RW, Goossens H, Auckenthaler R, Olmsted SS, De Lavison JF, Nordqvist K (2011). Diagnostics as essential tools for containing antibacterial resistance. Drug Resistance Updates 14:95-106.

Padmanabha TS, Nandini T, Manu G, Madhav KS, Ravi SM (2016). Knowledge, attitude and practices of antibiotic usage among the medical undergraduates of a tertiary care teaching hospital: an observational cross-sectional study. International Journal of Basic and Clinical Pharmacology 5:2432-2436.

Pereira NR, Castro-Sanchez E, Nathwani D (2017). How can multiprofessional education support better stewardship. Infectious Disease Reports 9:6917.

Prestinaci F, Pezzotti P, Pantosti A (2015). Antimicrobial resistance: a global multifaceted phenomenon. Pathogens and Global Health 109(7):309-318.

Pulcini C, Gyssens IC (2013). How to educate prescribers in antimicrobial stewardship practices. Virulence 4:192-202.

Pulcini C, Williams F, Molinari N, Davey P, Nathwani D (2011). Junior doctors’ knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland. Clinical Microbiology and Infection 17:80-87.

Roca I, Akova M, Baquero F, Carlet J, Cavaleri M, Coenen S, ... Vila J (2015). The global threat of antimicrobial resistance: science for intervention. New Microbes New Infection 6:22-29.

San Francisco CN, Toro MD, Cobo J, De Ge-Garcia J, Vano-Galvan S, Moreno Ramos F, ... Pano-Parodo JR (2013). Knowledge and perceptions of junior and senior Spanish resident doctors about antibiotic use and resistance: Results of a multicenter survey. Enfermedades Infecciosas y Microbiología Clínica 31:199-204.

Scaioli G, Gualano MR, Gili R, Masucci S, Bert F, Siliquini R (2015). Antibiotic use: a cross-sectional survey assessing the knowledge, attitudes and practices amongst students of a school of medicine in Italy. PLoS ONE 10:e0122476.

Schellack N, Pretorius R, Messina AP (2016). Esprit de corps’: Towards collaborative integration of pharmacists and nurses into antimicrobial stewardship programmes in South Africa South African Medical Journal 106(10):974.

Schwartz BS, Armstrong WS, Ohl CA, Luther VP (2015). Create allies, IDSA stewardship commitments should prioritize health professions learners. Clinical Infectious Diseases 61(10):1626-1627.

Schwartz BS, Chin-Hong PV (2017). A call to action: Infectious diseases medical educators needed. Journal of Infectious Diseases 216:600-605.

Schwartz DN (2016). Antimicrobial stewardship in US hospitals: Is the cup half-full yet? Clinical Infectious Diseases 63(4):450-453.

Schwartz S, Loeffler A, Kadle K (2016). Bacterial resistance to antimicrobial agents and its impact on veterinary and human medicine. Veterinary Dermatology 28(1):82-e19.

Schwartz BS, Armstrong WS, Ohl CA, Luther VP (2017). Create allies, IDSA stewardship commitments should prioritize health professions learners. Clinical Infectious Diseases 61:1626-1627.

Shanuga Vadivoo N, Usha B, Padmavathi BK (2015). Assessment of clinician’s knowledge and perception on antimicrobial resistance a primary strategy for antimicrobial resistance control. Global Journal Medical Research 15(4): https :// medical research journal .org /index.php/GJMR/article/view/982.

Shrayteh ZM, Rahal MK, Malaeb DN (2014). Practice of switch from intravenous to oral antibiotics. Springer Plus 3:717.

Speksnijder DC, Jaarsma ADC, Van Der Gugten AC, Verheij TJ, Wagenaar JA (2015). Determinants associated with veterinary antimicrobial prescribing in farm animals in the Netherlands: a qualitative study. Zoonoses and Public Health 62:39-51.

Published
2018-06-29
How to Cite
ANYANWU, M. U., OKORIE-KANU, O. J., ANYAOHA, C. O., & KOLADE, O. A. (2018). Veterinary Medical Students’ Perceptions, Attitude and Knowledge about Antibiotic Resistance and Stewardship: How Prepared Are Our Future Prescribers?. Notulae Scientia Biologicae, 10(2), 156-174. https://doi.org/10.15835/nsb10210258
Section
Research articles
CITATION
DOI: 10.15835/nsb10210258

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