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. 2020 Feb 14;9(1):33.
doi: 10.1186/s13756-020-0695-z.

Risk perception of the antimicrobial resistance by infection control specialists in Europe: a case-vignette study

Gabriel Birgand  1   2 , Nico T Mutters  3   4 , Raheelah Ahmad  5   6 , Evelina Tacconelli  3   7   8 , Jean-Christophe Lucet  3   9   10 , Alison Holmes  5   3 ; Percept-R Study Group
Collaborators, Affiliations

Risk perception of the antimicrobial resistance by infection control specialists in Europe: a case-vignette study

Gabriel Birgand et al. Antimicrob Resist Infect Control. .

Abstract

Background: Using case-vignettes, we assessed the perception of European infection control (IC) specialists regarding the individual and collective risk associated with antimicrobial resistance (AMR) among inpatients.

Methods: In this study, sixteen case-vignettes were developed to simulate hospitalised patient scenarios in the field of AMR and IC. A total of 245 IC specialists working in different hospitals from 15 European countries were contacted, among which 149 agreed to participate in the study. Using an online database, each participant scored five randomly-assigned case-vignettes, regarding the perceived risk associated with six different multidrug resistant organisms (MDRO). The intra-class correlation coefficient (ICC), varying from 0 (poor) to 1 (perfect), was used to assess the agreement for the risk on a 7-point Likert scale. High risk and low/neutral risk scorers were compared regarding their national, organisational and individual characteristics.

Results: Between January and May 2017, 149 participants scored 655 case-vignettes. The perceptions of the individual (clinical outcome) and collective (spread) risks were consistently lower than other MDRO for extended spectrum beta-lactamase producing Enterobacteriaceae cases and higher for carbapenemase producing Enterobacteriaceae (CPE) cases. Regarding CPE cases, answers were influenced more by the resistance pattern (93%) than for other MDRO. The risk associated with vancomycin resistant Enterococci cases was considered higher for the collective impact than for the individual outcome (63% vs 40%). The intra-country agreement regarding the individual risk was globally poor varying from 0.00 (ICC: 0-0.25) to 0.51 (0.18-0.85). The overall agreement across countries was poor at 0.20 (0.07-0.33). IC specialists working in hospitals preserved from MDROs perceived a higher individual (local, p = 0.01; national, p < 0.01) and collective risk (local and national p < 0.01) than those frequently exposed to bacteraemia. Conversely, IC specialists working in hospitals with a high MDRO clinical burden had a decreased risk perception.

Conclusions: The perception of the risk associated with AMR varied greatly across IC specialists and countries, relying on contextual factors including the epidemiology. IC specialists working in high prevalence areas may underestimate both the individual and collective risks, and might further negatively promote the MDRO spread. These finding highlight the need to shape local and national control strategies according to risk perceptions and contextual factors.

Keywords: Antimicrobial resistance; Carbapenemase-producing Acinetobacter baumannii; Carbapenemase-producing Enterobacteriaceae; Carbapenemase-producing Pseudomonas aeruginosa; Europe; Infection prevention and control; Meticillin-resistant Staphylococcus aureus; Risk perception; Vancomycin-resistant Enterococci.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overall assessment of agreement about risk perception within and across 15 European countries. Footnote: Individual risk corresponds to the risk of poor clinical outcomes for infected/colonised patients; collective risk corresponds to the risk for contact patients to become colonised and the transmission to other patients. N represents the total number of case-vignettes scored. The risk perception was scored on a 7-point Likert scale and then categorized in low risk for scores 1 to 3, neutral for a score of 4 and high risk for scores 5 to 7. Poor agreement: ICC < 0.4, Good agreement: ICC 0.4 to 0.7, Very good agreement: ICC > 0.7. Abbreviations: ICC, intraclass correlation; CI, confidence interval; UK, United Kingdom
See this image and copyright information in PMC

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