Evaluating patient attitudes to increased patient engagement with antimicrobial stewardship: a quantitative survey

BackgroundAntimicrobial stewardship (AMS) describes interventions designed to optimize antimicrobial therapy, minimize adverse treatment consequences and reduce the spread of antimicrobial resistance (AMR). Previous research has investigated the patient’s role in healthcare infection prevention but the patient’s role in AMS has not been extensively explored. ObjectivesTo investigate the willingness of hospital inpatients to question staff about prudent antimicrobial use in an Irish hospital and evaluate the impact of patient and public involvement in research (PPI) on this study. MethodsA survey was co-designed with the hospital Patient Representative Group (PRG) to evaluate patient willingness to engage with prudent antimicrobial treatment. A random sample of 200 inpatients was selected to self-complete the survey using pen and paper. PRG members provided feedback on their involvement. ResultsOf the 200 inpatients randomly selected to participate, 120 did not fulfil the inclusion criteria. Of the remaining 80, 67 participated (response 84%). Median respondent age was 58 years, 30% were employed and 30% had a third-level education degree. Over 90% had not heard of AMS while just over 50% had not heard of AMR. Patients preferred asking factual questions rather than challenging ones but did not have a preference in asking questions of doctors compared with nurses. Older patients were less likely to ask questions. PRG members reported an overall positive experience as research collaborators. Conclusions Future patient-centred AMS interventions should empower patients to ask about antimicrobial treatment, in particular the older patient cohort. PPI is a valuable component of patient-centred research.</div

Treatment response.

<p>Rates of sustained viral response (95% CI bars) with dual therapy in PWID (people who inject drugs) and non-PWID (a) for all genotypes– 64.1% ss 60.9% (b) genotype 1–48.6% vs 48.6% and (c) genotype 3–74.7% vs 73.3%.</p

Baseline patient characteristics of former and recent PWID and non-PWIDs treated for chronic HCV infection.

<p>Baseline patient characteristics of former and recent PWID and non-PWIDs treated for chronic HCV infection.</p

Adherence and treatment responses in people who inject drugs (PWID) and non-PWIDs.

<p>Adherence and treatment responses in people who inject drugs (PWID) and non-PWIDs.</p

The <i>IL28B</i> SNP, rs12979860, is associated with HCV treatment response in a cohort of HCV/HIV-1 co-infected patients.

<p>Patients that completed therapy were genotyped for the <i>IL28B</i> SNP (rs12979860) using a Taqman allele discrimination assay. Genotype frequencies were compared between patients who achieved SVR following treatment (n = 101) and those who did not achieve SVR (n = 48). Differences in frequency distribution between groups were tested for significance by a trend test.</p>1<p>Genotype for a subset of these patients, n = 72, has previously been described (Reference 16)</p

Main clinical characteristics of the population included in on-treatment analysis.

<p>Patients who completed a course of pegylated-IFN and Ribavirin therapy were included in the SVR analysis. SVR, sustained virological response; VL, viral load; Rx, treatment; ALT, alanine aminotransferase; AST, aspartate aminotransferase; HAART, highly active antiretroviral therapy; NS, not significant.</p

<i>KIR2DS3</i> gene frequency is increased in co-infected patients that fail to achieve SVR.

<p><i>KIR2DS3</i> was genotyped in our cohort by PCR-SSP. The carrier frequency of <i>KIR2DS3</i> in 149 HCV/HIV-1 co-infected treated with peg-IFN and ribavirin was compared in 101 patients who achieved SVR following treatment and 48 patients who did not achieve SVR. Differences in frequency populations were tested for significance by χ² test. Odds ratio with 95% confidence intervals is shown.</p

Additional file 1: of Reliability and validity of a new HIV-specific questionnaire with adults living with HIV in Canada and Ireland: the HIV Disability Questionnaire (HDQ)

Details of construct validity analysis. (DOCX 229 kb

The presence of both <i>KIR2DS3</i> and <i>IL28B-T</i> alleles synergise to increase the odds of HCV treatment failure.

<p>ORs for <i>KIR2DS3</i> alone, <i>IL28B-T</i> carriers (CT or TT) alone, and <i>KIR2DS3</i> with <i>IL28B-T</i> compared with neither risk factor present were calculated from multinominal logisitic regression. The contribution of individual and combined risk factors to the ORs is graphically represented in the bar chart. Positive OR indicates an association with increased odds of treatment failure. ^aOdds ratio (95% confidence interval). * adjusted OR including HCV genotype and HAART as co-variates.</p

The <i>IL28B</i> SNP, rs12979860, is associated with RVR in a cohort of HCV/HIV-1 co-infected patients.

<p>Patients were genotyped for the <i>IL28B</i>-associated SNP, rs12979860. Frequencies of the various genotypes were compared between patients that achieved an RVR (n = 61) and those that did not achieve RVR (n = 88) after 4 weeks of treatment. A χ² trend test was used to compare the data.</p