What do physicians think about evidence-based antibiotic use in critical care? A survey of Australian intensivists and infectious disease practitioners

Background: The analysis of factors that influence prescribing decisions is increasingly important. Antibiotic use is often based on limited evidence and lack of information about clinical decision-making processes is an impo rtant obstacle to improving antibiotic utilization. Aims: To compare the attitudes of intensive care unit practitioners (ICUP) and infectious disease practitioners (IDP) to antibiotic use and to the evi dence- based information support. Method: A postal survey conducted between March and July 2000 of ICUP and I DP representing all States and Territories in Australia. Results: One hundred and fifty-three of 224 clinicians returned the questio nnaire (68.3% response rate). In choosing an antibiotic, IDP placed signifi cantly more weight than ICUP on the in vitro susceptibility of the pathogen (P = 0.001), antibiotic cost (P = 0.05) and possible development of antibi otic resistance (P = 0.007). More than 95% of both groups believed that uni t-specific antibiotic susceptibility of endemic pathogens was an essential factor in rational prescribing, but only 68.5% of IDP and 38.7% of ICUP use microbiology laboratory databases. When in doubt about appropriate antibio tic use, 63.8% of ICUP seek and 76.3% usually follow the advice of IDP. Bot h groups agree that published antibiotic guidelines are useful, but IDP wer e more likely to consult them. ICUP were more likely to believe that guidel ines are used to control clinicians rather than to improve quality of care (P = 0.001). A greater proportion of IDP (71.2%) than ICUP (52.5%) believed that antibiotic prescribing in their intensive care unit (ICU) was evidenc e based but most (91.8% and 86.9%, respectively) agreed that it should be. Conclusions: Australian clinicians have positive views about evidence-based prescribing and antibiotic guidelines. However, there are clinically signi ficant differences in prescribing behaviour between ICUP and IDP. These may be explained by different disease spectra managed by each group or differe nt cultures, training and/or cognitive styles. Improvements in the understa nding of physicians' information and decision support needs are required to strengthen evidence-based prescribing.