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P71

Public engagement in promoting antibiotic awareness in Hong Kong

Suk Yee J. Leung, Ada W. Wong, Andrew T. Wong

1_{DEPARTMENT OF HEALTH, INFECTION CONTROL BRANCH, HONG KONG,}

Hong Kong

Correspondence:Suk Yee J. Leung

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P71

Introduction:Multi-drug resistant organisms (MDROs) are one of the most pressing issues in public health nowadays. The overuse and misuse of antibiotics has accelerated the spreading of MDROs. Infection Control Branch (ICB) launched out a "Use Anti- biotic Wisely. Prevent Antimicrobial Resistance" Video Competition in 2015-2016. The competition aims to raise public’s awareness on using antibiotic wisely so as to prevent antimicrobial resistance.

Objectives: To encourage general public especially the younger generation to support safe use of antibiotics and realize the anti- microbial resistance is a major threat to public health in Hong Kong.

Methods:A designated mini-web was developed to promote smart use of antibiotics and call for participation in video competition was launched out during Antibiotic Awareness Week (AAW) 2015. In addition, invitations to secondary school students to participate in the competition were disseminated by Education Bureau. Publicity in social media and briefing sessions on antibiotic awareness was arranged and conducted.

All submissions were assessed by professionals in infection control (IC) and film production. The champion and winners were selected by microbiologists. Final entries were uploaded to the website for public voting. The entry with highest number of votes of each category was awarded the Most Liked Award.

Results: There were 2 categories targeting general public and secondary school. A total of 32 video submissions (12 in secondary school categories and 20 in open category) were received. The 6 finalist entries were uploaded to social media (Facebook) for public voting. A total of 2,356 voters had selected their preferences.

Conclusion: The video competition is an innovative idea to promote antibiotic awareness programme which was successfully implemented in Hong Kong. Delivering the antibiotic awareness education through video competition among general public is the first of the kind in Hong Kong so far. In this program, we have also taken the opportunity to deliver health education to the participants through a briefing session and public health talk in the award ceremony. The submitted videos are full of cre- ativity and affective impact that has ability to engage viewers on the im- portance of "Use Antibiotic Wisely. Prevent Antimicrobial Resistance".

Disclosure of Interest

None Declared

P72

Using a theoretical model to explore nurse independent prescribers_’ antibiotic prescribing behaviour

Valerie Ness, Lesley Price, Kay Currie, Jacqui Reilly

Nursing and Community Health, Glasgow Caledonian University, Glasgow, United Kingdom

Correspondence:Jacqui Reilly

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P72

Introduction:Antimicrobial Resistance (AMR) is a major public health concern and inappropriate prescribing is a contributing factor, espe- cially when managing Upper Respiratory Tract Infections (URTI). More nurses than ever are now prescribing; however, little is known about their antibiotic prescribing behaviour.

Objectives: This mixed method study used the Reasoned Action Approach (RAA) (Fishbein & Ajzen 2010) to explore and measure nurses’ intention to manage patients, presenting with an URTI, without prescribing an antibiotic. The RAA suggests behaviour is in- fluenced by attitudes, perceived norms and perceived behavioural control (PBC).

Methods:In stage one, one-to-one telephone interviews took place with 27 Nurse Independent Prescribers (NIP) from across Scotland, to establish their most accessible beliefs. A RAA guided data collection tool was used and open-ended questions were asked to elicit the constructs. Inductive content analysis took place. Interviews were coded, categorised and then ranked in order of most frequently occurring categories.

Results: Attitude: Most frequently mentioned advantage for managing patients without prescribing an antibiotic was reducing AMR (n= 21;78%); disadvantage was the stress of patient expectation (n= 11;41%).

Perceived Norm: Most frequently mentioned groups, most likely to manage patients without prescribing were other NIPs (n= 11;41%); least were General Practitioners (n= 16;59%).

PBC: Most frequently mentioned barrier to managing patients without prescribing was patient pressure (n= 21;78%); most frequent enabler was time to manage patient expectations by giving advice (n= 27;100%).

Conclusion: This study has explored NIP antibiotic prescribing behaviour in patients with URTI. Implications for clinical practice are consideration of the effect of patient expectations and the challenges this creates when trying to manage patients without prescribing an antibiotic. Using a behavioural model allows researchers to understand the uniqueness of a behaviour and the factors that determine that behaviour. Findings from this study have informed the design of a national, cross-sectional survey, as a precursor to designing targeted in- terventions for NIP behaviour change.

References

Fishbein, M., Azjen, I. 2010, Predicting and Changing Behaviour: The Reasoned Action Approach. Psychology Press, New York.

Disclosure of Interest

P73

Knowledge, attitude and practice of appropriate use of antibiotics among primary health care workers in Zaria

Onoja-Alexander O. Mary1, Olorukooba A. AbdulHakeem2, Igboanusi C. John-Camillus3, Onoja D. Alexander4, Bulus B. Musa5

1_{Department of Community Medicine, Ahmadu Bello University}

Teaching Hospital;2_{Department of Community Medicine;}3_Department

of Community Medicine, Ahmadu Bello University Teaching Hospital Zaria, Zaria;4Wellcare Initiative Kano, Kano;5Department of Medicine, Gombe State University Teaching Hospital, Gombe, Nigeria

Correspondence:Onoja-Alexander O. Mary

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P73

Introduction: Antibiotic prescribing by primary health care (PHC) physicians and other health workers in the absence of bacterial infec- tions is a problem in many countries especially developing countries like Nigeria

Objectives:The aim of the study was to assess the knowledge, attitude and practice of appropriate use of antibiotics among PHC workers in Zaria.

Methods:A cross sectional descriptive study among 119 PHC workers who were selected using multi stage sampling technique.Data was col- lected using pre-tested semi-structured self-administered questionnaire. Data was analysed using SPSS version 21, Chi-square test was used to test for association and results presented in tables and charts.

Results:Majority (99.2%) of the respondents have heard of appropri- ate antibiotic use and correctly defined it (76.5%). Majority (91.6%) of them were aware of antibiotic resistance. Only 22.7% of respondents correctly knew that antibiotic is not the first line therapy in acute diarrhoeal disease. Only 19.3% had good knowledge Two-fifth (40.3%) of the respondents strongly agreed on the importance of knowing the resistance rate of the bacteria in the local setting while prescribing. Only 31.1% of the respondents had positive attitude. Ma- jority (63.9%) of the respondents prescribed antibiotics greater than once a day. Only 35.3% used generic name alone in their prescrip- tion and 35.2% of them usually request for Microscopy Culture and Sensitivity test before antibiotic prescription. About 17.1% had good practice of appropiate use of antibiotics.The three most common anti- biotics being prescribed were Amoyxl, Ampiclox and Co-trimoxazole.

Conclusion:Majority of the PHC workers in Zaria prescribed antibi- otics more than once a day, and their knowledge, attitude and prac- tice towards appropriate use of these drugs were poor. Hence there is the urgent need to train these PHC workers by the local health au- thorities on appropriate use of Antibiotics.

Disclosure of Interest

None Declared.

P74

Antibiotic stewardship in primary care: what is the best strategy?

Isabel Neves1,2,3, Gabriela Poças3,4, Ricardo C. Abreu1,2, Sofia Jordão1,2, Mario Guimarães1,2_{, Maria J. Soares}1,5_{, Ilda Devesa}3_{, Valquíria Alves}1,3,5 1

Antibiotic Stewardship Group;2Infectious Diseases Unit;3Infection Control and Antimicrobial Resistance Unit;4_{Primary Care;}5_Microbiology

Laboratory, Matosinhos Local Health Unit, Matosinhos, Portugal

Correspondence:Isabel Neves

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P74

Introduction:Portugal has a high rate of associated healthcare infec- tion, antibiotic prescription cares judicious use and antimicrobial resistance is worrying. Primary care (PC) prescribe 80% of all antibi- otics. In recognition of the urgent need to improve antibiotic use in this setting and reduce resistance, we apply an Antibiotic Steward- ship Program (ASP).

Objectives:To infer the benefits of ASP in PC in monitoring quino- lones prescription and antimicrobial resistance.

Methods:Our PC includes 20 care units and a proximity emergency unit and serves a population of 174931 inhabitants. Multimodal strategy: 1. Training in antibiotic therapy was provided to family

doctors, promoting its correct use. 2. Strategy front end: prescrip- tion according to national guidelines and community microbio- logical chart. 3 Selective report of antibiotic susceptibility test results as microbiology-based antibiotic stewardship intervention. 4. ASP Group available for proactive consulting and case talk. 5. Monitoring results discussion with medical coordinators/feedback to prescribers. Quinolone consumption data were taken from the PC prescription data base and the ATC and DDD system were used in the analysis of the data. Community microbiological chart are given annually by centralized microbiology laboratory and posted on the internet.

Results: In five years (2011 to 2016) quinolones consumption was audited, and there was a reduction from 0,75 to 0.40 DHD (2011 to 2016, respectively) and improved susceptibility ofE. coli to quino- lones from 79 to 86% and S. aureusto methicillin from 52 to 80% (2011 and 2016, respectively).

Conclusion: This strategy allowed to reduce direct quinolone antibiotic consumption and this was reflected in the decrease in anti- microbial resistance. Training, standard prescription, availability for proactive consulting and feedback to prescribers are tools that help judiciously use antibiotics in PC.

Disclosure of Interest

None Declared

P75

Knowledge of antibiotic resistance and proper antibiotic use among patients attending a private hospital in Zaria, North-Western Nigeria

Lawal Amadu1, Olorukooba A. Abdulhakim1, Aisha A. Abubakar1, Muawiyyah B. Sufiyan1_{, Bilyaminu B. Lawal}1_{, Shamsuddeen S. Yahaya}2_,

Muhammad S. Balogun3, Stephen Z. Bayero1, Bashir P. Zakariyya1

1_{Community Medicine Department, Ahmadu Bello University Zaria,}

Kaduna state, Nigeria, Zaria;2Katsina state primary Health Care Development Agency, Katsina state ministry of Health, Katsina,3_African

Field Epidemiology Network, AFENET, Abuja, Nigeria

Correspondence:Lawal Amadu

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P75

Introduction:Antibiotics resistance is a major public health problem globally. The main contributor to this problem is human behaviours at various levels. Understanding the knowledge and attitude of pa- tients and the general public towards antibiotics resistance is key to controlling this public health problem.

Objectives:We aimed at determining the knowledge of antibiotic re- sistance and proper antibiotic use among patients attending a pri- vate hospital in Zaria, North-Western Nigeria.

Methods: A cross sectional descriptive study was carried out among 340 respondents selected using a systematic random sam- pling technique. A pretested self-administered questionnaire was used to elicit information from the respondents. Data was ana- lysed using IBM SPSS version 21.0. Bivariate analysis was done using chi-square test and a p-value≤0.05 was considered statisti- cally significant.

Results:Only 9.71% of the respondents had good knowledge of antibiotics resistance while 16.47% appropriately used antibiotics. The average monthly income of the respondents was associated with knowledge of antibiotic resistance (p< 0.001) and proper antibiotic use (p< 0.001). Occupation of respondents, level of education and knowledge of antibiotic resistance were associated with proper antibiotic use (p< 0.001, p< 0.001 and p< 0.001 respectively).

Conclusion:There was poor knowledge of antibiotic resistance and low prevalence of appropriate antibiotic use among the respondents. Therefore, educational interventions are needed to promote appro- priate use of antibiotics among the public.

Disclosure of Interest

P76

Ampiclox: antibiotic or analgesic? Self-reported use of ampiclox among farmers and labourers in rural communities in the Nigerian State of Kano

Ibrahim Yusuf1, Abdulhakeem Gbadamosi2, Musa Haruna3, Sani Yahaya1

1_{Microbiology, Bayero University, Kano, Kano;}2_{Nephrology, Federal}

Medical Center, Katsina, Katsina;3_{Biology, Kano University of Science and}

Technology, Wudil, Kano, Nigeria

Correspondence:Ibrahim Yusuf

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P76

Introduction: The proliferation of substandard Ampicillin and cloxacillin antibiotics (popularly known as Ampiclox) and their abuse, especially in the rural communities in Nigeria is highly worrisome. Three separate encounters with some farmers and labourers pur- chasing and using Ampiclox as a pain reliever at some different un- registered drug stores operated by non-educated personnel in rural areas necessitated the conduct of this study.

Objectives:The main objective of the study is to assess the know- ledge and practice of randomly selected farmers and labourers (males and females) in rural areas toward use of Ampiclox.

Methods:A survey of 200 farmers and labourers (100 each) recruited from 3 selected local government areas of Kano, North-West Nigeria was conducted by means of a self-report drug-use questionnaire and interview in October 2016.

Results: The majority of respondents (87%) lack formal education and were from a low socio-economic class that lived below $2 daily. About 75% of them had self-used Ampiclox capsules before the study, and 26% (52/200) had used it for at least a time as a pain re- liever. Further, 23% of farmers and 15% of labourers had used a dose of Ampiclox for at least a time to relieve pain after hectic work prior to the study. However, 76 respondents (38%) have the knowledge that Ampiclox is used to treat boils and rashes. Another 48% be- lieved that Ampiclox is very good in treating fresh wounds only. Of the total respondents (151) who had self-used Ampiclox before, 35.0%, 31.7%, 23.8%, 9.2% had used only two capsules of Ampiclox to treat boils, rashes, wound infections and body pain respectively. Only 9% had used the complete dosage of Ampiclox for the treatment of either wound infections, rashes or boils. Low use of Ampiclox as a pain reliever was recorded among labourers when compared with farmers. Males used Ampiclox for painkiller signifi- cantly more than females (34:18). The majority of respondent's know- ledge of using Ampiclox as a painkiller came from either families, friends and/or medical store attendants.

Conclusion: The authors stressed the need to develop a viable antibiotic-abuse preventive programme in the rural area to educate members of the communities on prudence use of antibiotics.

Disclosure of Interest

None Declared.

P77

Knowledge of antibiotic resistance and appropriate use of antibiotics in children among caregivers in semi-urban community of Kaduna State Northwest Nigeria

Muawiyyah B. Sufiyan1, Daniel A. John1, Shafi'u Mohammed2

1_{Community Medicine;}2_{Clinical Pharmacy, Ahmadu Bello University,}

Zaria, Kaduna, Nigeria

Correspondence:Muawiyyah B. Sufiyan

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P77

Introduction:Globally, antibiotic resistance has led to higher medical costs, prolonged hospital stays and increased mortality. Irrational use of antibiotics has been shown to be the major factor driving the spread of resistance.

Objectives:The aim of this study is to assess the knowledge of care- givers in Basawa community on antibiotic resistance and appropriate use of antibiotics in their children.

Methods:We conducted a community based cross sectional descrip- tive study among 242 caregivers of children below the age of five years that were selected via cluster sampling technique. A pretested semi structured interviewer administered questionnaire was used for data collection. The collected data was then entered into a computer, validated and analyzed using statistical package for social sciences software (IBM SPSS) version 21.0 and results were presented in tables and charts.

Results: Majority of the respondents (79.0%) were within the age group of 15-34 years with a mean age of 28.24 (+8.43 years). Female respondents constitute 67.4% and 48.3% of all respondents have attained secondary level of education. Most of the respondents have never heard about antibiotic resistance (73.4%). At least three- quarter (77.5%) of them had poor knowledge on antibiotic resistance. More than half (63.3%) of the respondents had negative perception on antibiotic resistance while 80.9% of them used antibiotics inappropriately. Level of education was a strong predictor of percep- tion (p= 0.000) and appropriate antibiotic use (p= 0.032).

Conclusion:Poor knowledge and negative perception on antibiotic resistance was prevalent among caregivers in studied community. They also use antibiotics on their children inappropriately, thereby contributing towards the prevailing problem of antibiotic resistance. More time and resources therefore need to be invested in awareness creation and educating the populace, especially caregivers of children on antibiotic resistance.

Disclosure of Interest

None Declared

P78

Evaluating the utility of icd-10 codes for outpatient antimicrobial stewardship

Daniel J. Livorsi1, 2_{, Carrie Linn}2_{, Bruce Alexander}1_{, Traviss Tubbs}1_,

Eli Perencevich1, 2

1_{Iowa City VA Health Care System;}2_{University of Iowa Carver College of}

Medicine, Iowa City, United States

Correspondence:Daniel J. Livorsi

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P78

Introduction: Audit-and-feedback can promote outpatient antimicro- bial stewardship, but it is unclear if international classification of disease (ICD) codes can reliably identify antimicrobial-prescribing opportunities.

Objectives: We sought to define the frequency at which ICD-10 codes are entered for antimicrobial-prescribing visits and whether these codes have diagnostic validity.

Methods:Antimicrobial prescriptions from our medical center were retrospectively reviewed if the prescription originated from primary care or the emergency department (ED) during 2016. For each antimicrobial-prescribing visit, we sought a relevant ICD-10 code en- tered for that encounter that identified the indication for antimicro- bials. If no relevant code was entered, chart review was performed to identify the provider’s diagnosis. For all cases of cystitis and pneumo- nia, the diagnosis was validated using standardized criteria.

Results: There were 2,353 antimicrobial prescriptions from 52 pro- viders. The most common reasons for prescribing antimicrobials were acute respiratory tract infections (ARTIs, 35.0%), skin-soft tissue infec- tions (17.0%), and cystitis (14.4%). The most commonly prescribed agents were macrolides (17.6%), amoxicillin-clavulanate (17.0%), and fluoroquinolones (15.3%). All prescriptions included at least one refill. A relevant ICD-10 code was entered for 1153 (49.8%) antimicrobial- prescribing visits, including 529 (64.2%) ARTI-related visits. Among 17 providers who wrote≥20 antimicrobial prescriptions, the median fre- quency of entering a relevant ICD-10 code was 60.2% (IGQ 44.7- 75.0%). There was significant variability across providers in the fre- quency of using relevant ICD-10 codes for antimicrobial-prescribing visits (p< 0.01).

ICD-10 codes performed poorly in identifying cases of true cystitis (n= 284) and pneumonia (n = 94). The sensitivity, specificity, posi-

tive predictive value and negative predictive value were 66.3%, 59.8%, 76.1%, 59.8% for cystitis and 58.9%, 31.6%, 55.9%, 34.3% for pneumonia.

Conclusion:Performing antimicrobial audits based on ICD-10 codes would overlook a large proportion of outpatient antimicrobial- prescribing visits at our medical center. ICD-10 codes were neither sensitive nor specific in identifying true cases of pneumonia or cystitis.

Disclosure of Interest

None Declared

P79

Outpatient antibiotic consumption in Switzerland: trends over the years 2013–2015 and comparison with Europe

Catherine Plüss-Suard1_{, Andreas Kronenberg}2_{, Giorgio Zanetti}1_{on behalf}

of the Swiss Centre for Antibiotic Resistance (anresis.ch)

1_{CHUV, Lausanne;}2_{University of Bern, Bern, Switzerland}

Correspondence:Catherine Plüss-Suard

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P79

Introduction: Surveillance of antibiotic (AB) consumption is a key component of AB stewardship activities (1).

Objectives:Our objectives were to describe AB consumption in the outpatient setting in Switzerland in the frame of the programme anresis.ch and to compare it to European antibiotic use level.

Methods: AB for systemic use (class J01 of WHO Anatomical Therapeutic Chemical system, 2017) were collected over the years 2013-2015 through the billing office of the Swiss Pharmacist_’s Association. Aggregated data were converted into defined daily doses (DDD) and AB use expressed in DDD per 1000 inhabitants and per day (DID).

Results: Global AB consumption (5.7 DID in 2013, and 5.5 in 2015, -3%) was relatively low compared with European coun- tries participating to ESAC-Net (20.1 in 2013, and 20.7 in 2015, +3%) (2). It was higher in the French- (12.0 and 11.2 DID resp.,