A global investigation into antimicrobial knowledge in medicine, pharmacy, nursing, dentistry and veterinary undergraduate students: A scoping review to inform future planetary health multidisciplinary education.

Antimicrobial prescribing antimicrobial resistance antimicrobial stewardship attitude interprofessional education knowledge multidisciplinary practice scoping review undergraduate

Journal

BMC medical education
ISSN: 1472-6920
Titre abrégé: BMC Med Educ
Pays: England
ID NLM: 101088679

Informations de publication

Date de publication:
29 Oct 2024
Historique:
received: 26 06 2024
accepted: 24 10 2024
medline: 29 10 2024
pubmed: 29 10 2024
entrez: 29 10 2024
Statut: epublish

Résumé

Inappropriate use of antimicrobials can push the environment out of balance, and cause unnecessary waste that can contaminate our soil, animals and waterways. Health professional education is committed to preparing students for antimicrobial stewardship (AMS) and supporting planetary health, but a more multidisciplinary action is needed to curb the expansion of antimicrobial resistance (AMR). The aim of this scoping review is to showcase the current antimicrobial knowledge of undergraduate students across the disciplines of medicine, pharmacy, nursing, dentistry and veterinary. This will consequently showcase the gaps and trends across the different disciplines and countries to help inform planetary health multidisciplinary undergraduate curriculums. A search of the existing literature published prior to December 2023 was conducted using CINAHL, EMBASE, MEDLINE, SCOPUS, and ERIC databases. Studies were excluded if they included postgraduate students or discussed the knowledge, attitude and practice (KAP) of students towards antimicrobial prescribing, AMR and AMS related to a specific learning activity. A total of 144 articles were included. The most represented countries were India and Pakistan accounting for 17% and 8% of the studies, respectively. Single-disciplinary research accounted for approximately 80% of the studies. Medicine was the most represented discipline in both single-disciplinary and multidisciplinary research, appearing in approximately 62% of the studies, followed by pharmacy appearing in approximately 30% of the studies and dentistry appearing in approximately 18% of the studies. Three major priority themes were identified: students are more familiar with the term AMR compared to AMS; inappropriate use of antimicrobials is seen as the main driver of AMR; and the need for more training and education in the field of appropriate antimicrobial prescribing, AMR and AMS. This review has highlighted that there is a need for more AMS interprofessional education (IPE) activities in all five disciplines, and especially within the disciplines of nursing, veterinary and dentistry, as shown by a lack of multidisciplinary research in this area. Most of the knowledge assessments have just touched the surface of AMS and focused on inappropriate antimicrobial use alone. Interdisciplinary planetary health education needs to go beyond these skills and broaden the understanding of other factors that can contribute to AMR such as inappropriate disposal, environmental contamination, monitoring and surveillance, one health, false allergies, and more importantly, how each health professional can contribute to a team.

Sections du résumé

BACKGROUND BACKGROUND
Inappropriate use of antimicrobials can push the environment out of balance, and cause unnecessary waste that can contaminate our soil, animals and waterways. Health professional education is committed to preparing students for antimicrobial stewardship (AMS) and supporting planetary health, but a more multidisciplinary action is needed to curb the expansion of antimicrobial resistance (AMR). The aim of this scoping review is to showcase the current antimicrobial knowledge of undergraduate students across the disciplines of medicine, pharmacy, nursing, dentistry and veterinary. This will consequently showcase the gaps and trends across the different disciplines and countries to help inform planetary health multidisciplinary undergraduate curriculums.
METHODS METHODS
A search of the existing literature published prior to December 2023 was conducted using CINAHL, EMBASE, MEDLINE, SCOPUS, and ERIC databases. Studies were excluded if they included postgraduate students or discussed the knowledge, attitude and practice (KAP) of students towards antimicrobial prescribing, AMR and AMS related to a specific learning activity.
RESULTS RESULTS
A total of 144 articles were included. The most represented countries were India and Pakistan accounting for 17% and 8% of the studies, respectively. Single-disciplinary research accounted for approximately 80% of the studies. Medicine was the most represented discipline in both single-disciplinary and multidisciplinary research, appearing in approximately 62% of the studies, followed by pharmacy appearing in approximately 30% of the studies and dentistry appearing in approximately 18% of the studies. Three major priority themes were identified: students are more familiar with the term AMR compared to AMS; inappropriate use of antimicrobials is seen as the main driver of AMR; and the need for more training and education in the field of appropriate antimicrobial prescribing, AMR and AMS.
CONCLUSION CONCLUSIONS
This review has highlighted that there is a need for more AMS interprofessional education (IPE) activities in all five disciplines, and especially within the disciplines of nursing, veterinary and dentistry, as shown by a lack of multidisciplinary research in this area. Most of the knowledge assessments have just touched the surface of AMS and focused on inappropriate antimicrobial use alone. Interdisciplinary planetary health education needs to go beyond these skills and broaden the understanding of other factors that can contribute to AMR such as inappropriate disposal, environmental contamination, monitoring and surveillance, one health, false allergies, and more importantly, how each health professional can contribute to a team.

Identifiants

pubmed: 39468598
doi: 10.1186/s12909-024-06253-w
pii: 10.1186/s12909-024-06253-w
doi:

Substances chimiques

Anti-Infective Agents 0

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1227

Informations de copyright

© 2024. The Author(s).

Références

Danner MC, et al. <ArticleTitle Language=“En”>Antibiotic pollution in surface fresh waters: occurrence and effects. Sci Total Environ. 2019;664:793–804.
doi: 10.1016/j.scitotenv.2019.01.406
Ellabaan MMH, et al. Forecasting the dissemination of antibiotic resistance genes across bacterial genomes. Nat Commun. 2021;12(1):2435.
doi: 10.1038/s41467-021-22757-1
Walsh TR, et al. Antimicrobial Resistance: Addressing a Global Threat to Humanity. PLoS Med. 2023;20(7):e1004264.
doi: 10.1371/journal.pmed.1004264
World Health Organisation. Promoting antimicrobial stewardship to tackle antimicrobial resistance. 2021 January 24, 2024]; https://www.who.int/europe/activities/promoting-antimicrobial-stewardship-to-tackle-antimicrobial-resistance
Lanckohr C, Bracht H. Antimicrobial stewardship. Curr Opin Crit Care. 2022;28(5):551–6.
doi: 10.1097/MCC.0000000000000967
Przymuszała P, et al. Factors influencing behavioral intentions of graduating pharmacy students regarding interprofessional collaboration - a theory-driven qualitative study. BMC Health Serv Res. 2023;23(1):1207.
doi: 10.1186/s12913-023-10224-0
World Health Organisation. Framework for Action on Interprofessional Education & Collaborative Practice. 2010 January 26, 2024]; https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice
Alsaleh N, et al. Medical and dental students’ knowledge and perceptions about antimicrobial stewardship: a call for educational enhancement. Military Med Sci Lett (Vojenske Zdravotnicke Listy). 2020;89(4):207–14.
doi: 10.31482/mmsl.2020.019
Patel N, Begum S, Kayyali R. Interprofessional Education (IPE) and Pharmacy in the UK. A Study on IPE Activities across Different Schools of Pharmacy. Pharm (Basel), 2016. 4(4).
Pulcini C, Gyssens IC. How to educate prescribers in antimicrobial stewardship practices. Virulence. 2013;4(2):192–202.
doi: 10.4161/viru.23706
Silverberg SL, et al. A review of antimicrobial stewardship training in medical education. Int J Med Educ. 2017;8:353–74.
doi: 10.5116/ijme.59ba.2d47
Peters MD et al. JBI manual for evidence synthesis. JBI Manual for Evidence Synthesis, 2020: pp. 406–451.
LIBRARY MU. Systematic Review: Review & test your search. 2024 24/06/2024]; https://guides.lib.monash.edu/systematic-review/review-and-test-your-search
Covidence software. Veritas Health Innovation, Melbourne, Australia.
Wright E, Jain P. Survey of antibiotic knowledge amongst final year medical students. J Antimicrob Chemother. 2004;53(3):550–1.
doi: 10.1093/jac/dkh096
Minen MT, et al. A survey of knowledge, attitudes, and beliefs of medical students concerning antimicrobial use and resistance. Microb Drug Resist. 2010;16(4):285–9.
doi: 10.1089/mdr.2010.0009
Bp S et al. Survey on knowledge towards antibiotics among the nursing students. Int J Pharm Pharm Sci, 2011. 3.
Bouchoucha SL, et al. Nursing students’ awareness and perceptions of nurses’ role in antimicrobial stewardship. Nurse Educ Pract. 2021;52:103036.
doi: 10.1016/j.nepr.2021.103036
Khan FU, et al. Exploring Undergraduate Pharmacy Students Perspectives Towards Antibiotics Use, Antibiotic Resistance, and Antibiotic Stewardship Programs Along With the Pharmacy Teachers’ Perspectives: A Mixed-Methods Study From Pakistan. Front Pharmacol. 2021;12:754000.
doi: 10.3389/fphar.2021.754000
Schneider-Smith EG, et al. How decisions are made: Antibiotic stewardship in dentistry. Infect Control Hosp Epidemiol. 2023;44(11):1731–6.
doi: 10.1017/ice.2023.173
Wiese-Posselt M, et al. Appropriate antibiotic use and antimicrobial resistance: knowledge, attitudes and behaviour of medical students and their needs and preferences for learning. Antimicrob Resist Infect Control. 2023;12(1):48.
doi: 10.1186/s13756-023-01251-x
Primeau CA, et al. Exploring medical and veterinary student perceptions and communication preferences related to antimicrobial resistance in Ontario, Canada using qualitative methods. BMC Public Health. 2023;23(1):483.
doi: 10.1186/s12889-023-15193-x
Vázquez-Lago JM et al. Knowledge, Perceptions, and Perspectives of Medical Students Regarding the Use of Antibiotics and Antibiotic Resistance: A Qualitative Research in Galicia, Spain. Antibiot (Basel), 2023. 12(3).
Dyar OJ et al. Assessing the Knowledge, Attitudes and Behaviors of Human and Animal Health Students towards Antibiotic Use and Resistance: A Pilot Cross-Sectional Study in the UK. Antibiot (Basel), 2018. 7(1).
AboAlSamh A, et al. Dental Students’ Knowledge and Attitudes towards Antibiotic Prescribing Guidelines in Riyadh, Saudi Arabia. Volume 6. Pharmacy (Basel); 2018. 2.
Anandakumar S, Sankari R. Knowledge, attitude and practice on antibiotic therapy among dental students-a pilot study. Res J Pharm Technol. 2018;11(6):2473–5.
doi: 10.5958/0974-360X.2018.00456.0
Hanweet DM, Mahdi KA, Ahmed AQ. Knowledge and Attitude of Antibiotic Prescription Among Dental Students in Najaf City, Iraq. Int Neurourol J. 2023;27(4):1387–91.
Indrapriyadharshini K et al. Knowledge about antibiotic resistance among dental students in Chengalpattu district, Tamil Nadu – A cross-sectional study. J Global Oral Health, 2021. 4.
Chokshi A et al. Global Contributors to Antibiotic Resistance. J Global Infect Dis, 2019. 11(1).
Kotwani A, Joshi J, Lamkang AS. Over-the-Counter Sale of Antibiotics in India: A Qualitative Study of Providers’ Perspectives across Two States. Antibiot (Basel), 2021. 10(9).
Majid Aziz M et al. Dispensing of Non-Prescribed Antibiotics from Community Pharmacies of Pakistan: A Cross-Sectional Survey of Pharmacy Staff’s Opinion. Antibiot (Basel), 2021. 10(5).
Okeke IN, Lamikanra A, Edelman R. Socioeconomic and behavioral factors leading to acquired bacterial resistance to antibiotics in developing countries. Emerg Infect Dis. 1999;5(1):18–27.
doi: 10.3201/eid0501.990103
Dadgostar P. Antimicrobial Resistance: Implications and Costs. Infect Drug Resist. 2019;12:3903–10.
doi: 10.2147/IDR.S234610
Charani E, Cooke J, Holmes A. Antibiotic stewardship programmes—what’s missing? J Antimicrob Chemother. 2010;65(11):2275–7.
doi: 10.1093/jac/dkq357
Rusic D, et al. Antimicrobial resistance: physicians’ and pharmacists’ perspective. Microb Drug Resist. 2021;27(5):670–7.
doi: 10.1089/mdr.2020.0272
Australian Commission on Safety and Quality in Health Care. Role of prescribers in antimicrobial stewardship. 2018 08/03/2024]; https://www.safetyandquality.gov.au/sites/default/files/migrated/Chapter10-Role-of-prescribers-in-antimicrobial-stewardship.pdf
Simpson SA, Wood F, Butler CC. General practitioners’ perceptions of antimicrobial resistance: a qualitative study. J Antimicrob Chemother. 2006;59(2):292–6.
doi: 10.1093/jac/dkl467
Zgliczyński WS, Bartosiński J, Rostkowska OM. Knowledge and Practice of Antibiotic Management and Prudent Prescribing among Polish Medical Doctors. Int J Environ Res Public Health, 2022. 19(6).
American Journal of Health-System Pharmacy. ASHP Statement on the Pharmacist’s Role in Antimicrobial Stewardship and Infection Prevention and Control. Am J Health-System Pharm. 2010;67(7):575–7.
doi: 10.2146/sp100001
Australian Commission on Safety and Quality in Health Care. Role of the pharmacist and pharmacy services in antimicrobial stewardship. 2018 08/03/2024]; https://www.safetyandquality.gov.au/sites/default/files/migrated/Chapter11-Role-of-the-pharmacist-and-pharmacy-services-in-antimicrobial-stewardship.pdf
Dyar OJ, Tebano G, Pulcini C. Managing responsible antimicrobial use: perspectives across the healthcare system. Clin Microbiol Infect. 2017;23(7):441–7.
doi: 10.1016/j.cmi.2017.04.016
Garau J, Bassetti M. Role of pharmacists in antimicrobial stewardship programmes. Int J Clin Pharm. 2018;40(5):948–52.
doi: 10.1007/s11096-018-0675-z
Lai WM et al. Pharmacists’ Perspectives of Their Roles in Antimicrobial Stewardship: A Qualitative Study among Hospital Pharmacists in Malaysia. Antibiot (Basel), 2022. 11(2).
Edwards R, et al. Covering more Territory to Fight Resistance: Considering Nurses’ Role in Antimicrobial Stewardship. J Infect Prev. 2011;12(1):6–10.
doi: 10.1177/1757177410389627
Rábano-Blanco A et al. Nursing Students’ Knowledge and Awareness of Antibiotic Use, Resistance and Stewardship: A Descriptive Cross-Sectional Study. Antibiot (Basel), 2019. 8(4).
Cooper L, et al. Tackling antimicrobial resistance in practice: dental students’ evaluation of university teaching supplemented by an online course. JAC Antimicrob Resist. 2022;4(2):dlac039.
doi: 10.1093/jacamr/dlac039
Suda KJ, et al. Assessment of the Appropriateness of Antibiotic Prescriptions for Infection Prophylaxis Before Dental Procedures, 2011 to 2015. JAMA Netw Open. 2019;2(5):e193909–193909.
doi: 10.1001/jamanetworkopen.2019.3909
Teoh L, Thompson W, Suda K. Antimicrobial stewardship in dental practice. J Am Dent Association. 2020;151(8):589–95.
doi: 10.1016/j.esmoop.2020.04.023
Bengtsson B, Greko C. Antibiotic resistance—consequences for animal health, welfare, and food production. Ups J Med Sci. 2014;119(2):96–102.
doi: 10.3109/03009734.2014.901445
Dyar OJ, et al. What is antimicrobial stewardship? Clin Microbiol Infect. 2017;23(11):793–8.
doi: 10.1016/j.cmi.2017.08.026
Abbo LM, et al. Medical Students’ Perceptions and Knowledge About Antimicrobial Stewardship: How Are We Educating Our Future Prescribers? Clin Infect Dis. 2013;57(5):631–8.
doi: 10.1093/cid/cit370
Luther VP, Ohl CA, Hicks LA. Antimicrobial Stewardship Education for Medical Students. Clin Infect Dis. 2013;57(9):1366–1366.
doi: 10.1093/cid/cit480
MacDougall C et al. An Interprofessional Curriculum on Antimicrobial Stewardship Improves Knowledge and Attitudes Toward Appropriate Antimicrobial Use and Collaboration. Open Forum Infect Dis, 2017. 4(1).
Satterfield J, Miesner AR, Percival KM. The role of education in antimicrobial stewardship. J Hosp Infect. 2020;105(2):130–41.
doi: 10.1016/j.jhin.2020.03.028
Efthymiou P, Gkentzi D, Dimitriou G. Knowledge, Attitudes and Perceptions of Medical Students on Antimicrobial Stewardship. Antibiot (Basel), 2020. 9(11).
Vickers H. International antibiotic resistance crisis. British Medical Journal Publishing Group; 2011.
World Health Organisation. The evolving threat of antimicrobial resistance - Options for action. 2012 09/03/2024]; https://iris.who.int/bitstream/handle/10665/44812/?sequence=1
Bal AM, Gould IM. Antibiotic stewardship: overcoming implementation barriers. Curr Opin Infect Dis. 2011;24(4):357–62.
doi: 10.1097/QCO.0b013e3283483262
Johnson LS, MacDougall C, Trivedi KK. The Legislative Momentum of Antimicrobial Stewardship: the US Perspective. Curr Treat Options Infect Dis. 2016;8(2):93–101.
doi: 10.1007/s40506-016-0076-6
Scheepers LN, Niesing CM, Bester P. Facilitators and barriers to implementing antimicrobial stewardship programs in public South African hospitals. Antimicrob Steward Healthc Epidemiol. 2023;3(1):e34.
doi: 10.1017/ash.2022.355
Australian Commission on Safety and Quality in Health Care. Antimicrobial stewardship education for clinicians. 2018 09/03/2024]; https://www.safetyandquality.gov.au/sites/default/files/migrated/Chapter5-Antimicrobial-stewardship-education-for-clinicians.pdf
Alm RA, Lahiri SD. Narrow-Spectrum Antibacterial Agents-Benefits and Challenges. Antibiot (Basel), 2020. 9(7).
Karam G, et al. Antibiotic strategies in the era of multidrug resistance. Crit Care. 2016;20(1):136.
doi: 10.1186/s13054-016-1320-7
Melander RJ, Zurawski DV, Melander C. Narrow-Spectrum Antibact Agents Medchemcomm. 2018;9(1):12–21.
Fishman N, America SfHEo, America IDSo. Policy statement on antimicrobial stewardship by the society for healthcare epidemiology of America (SHEA), the infectious diseases society of America (IDSA), and the pediatric infectious diseases society (PIDS). Infect Control Hosp Epidemiol. 2012;33(4):322–7.
doi: 10.1086/665010
Castro-Sánchez E, et al. Mapping Antimicrobial Stewardship in Undergraduate Medical, Dental, Pharmacy, Nursing and Veterinary Education in the United Kingdom. PLoS ONE. 2016;11(2):e0150056.
doi: 10.1371/journal.pone.0150056
Chakravarty A et al. A Multicentric Survey of Indian Medical Students about their Knowledge and Perception on Antimicrobial Stewardship. J Pure Appl Microbiol, 2022. 16(2).
Khan AKA, Banu G, K KR. Antibiotic Resistance and Usage-A Survey on the Knowledge, Attitude, Perceptions and Practices among the Medical Students of a Southern Indian Teaching Hospital. J Clin Diagn Res. 2013;7(8):1613–6.
Melber DJ, Teherani A, Schwartz BS. A Comprehensive Survey of Preclinical Microbiology Curricula Among US Medical Schools. Clin Infect Dis. 2016;63(2):164–8.
doi: 10.1093/cid/ciw262
Lim A, et al. Assessment of Antimicrobial Stewardship through objective structured clinical examination in pharmacy education. Int J Pharm Pract. 2023;31(6):646–9.
doi: 10.1093/ijpp/riad048
Foral PA, et al. Education and Communication in an Interprofessional Antimicrobial Stewardship Program. J Am Osteopath Assoc. 2016;116(9):588–93.
Chetty S, et al. Interprofessional education in antimicrobial stewardship, a collaborative effort. JAC Antimicrob Resist. 2024;6(2):dlae054.
doi: 10.1093/jacamr/dlae054

Auteurs

Shahd Alzard (S)

Monash University, Melbourne, VIC, 3052, Australia.

Betty Exintaris (B)

Monash University, Melbourne, VIC, 3052, Australia.

Mahbub Sarkar (M)

Monash University, Melbourne, VIC, 3052, Australia.

Averil Grieve (A)

Monash University, Melbourne, VIC, 3052, Australia.

Sara Chuang (S)

Monash University, Melbourne, VIC, 3052, Australia.

Renier Coetzee (R)

School of Public Health, University of the Western Cape, Cape Town, South Africa.

Angelina Lim (A)

Monash University, Melbourne, VIC, 3052, Australia. angelina.lim@monash.edu.
Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, 3052, Australia. angelina.lim@monash.edu.
Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia. angelina.lim@monash.edu.

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