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.

中文翻译：

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欧洲感染控制专家对抗菌素耐药性的风险感知：个案研究。

背景技术我们使用病例短片评估了欧洲感染控制（IC）专家对住院患者中与抗菌素耐药性（AMR）相关的个体和集体风险的看法。方法在本研究中，开发了16个病例插图，以模拟AMR和IC领域的住院患者情况。与来自15个欧洲国家/地区的不同医院的245位IC专家进行了联系，其中149位同意参加该研究。使用在线数据库，每个参与者对与六个不同的耐多药耐药生物（MDRO）相关的感知风险评分了五个随机分配的病例。类内相关系数（ICC）从0（差）到1（完美）不等，用于评估7点Likert量表的风险一致性。对高风险和低/中性风险评分者的国家，组织和个人特征进行了比较。结果2017年1月至2017年5月之间，有149位参与者对655个案例进行了评分。对于产生广谱β-内酰胺酶的肠杆菌科病例，个人（临床结果）和集体（扩散）风险的认知始终低于其他MDRO，而对于产生碳青霉烯酶的肠杆菌科（CPE）病例，其感知始终较低。对于CPE案例，抵抗方式（93％）对答案的影响比对其他MDRO的影响更大。与万古霉素耐药的肠球菌病例相关的风险被认为是集体影响高于个体结局（63％vs 40％）。关于个人风险的国家内部协议总体上较差，从0.00（ICC：0-0.25）到0.51（0。18-0.85）。各国之间的总体协议较差，为0.20（0.07-0.33）。在MDRO保留下来的医院工作的IC专家比经常暴露于菌血症的人具有更高的个人（局部，p = 0.01；国家，p <0.01）和集体风险（局部和国家p <0.01）。相反，在MDRO临床负担高的医院工作的IC专家的风险感知降低。结论依赖于流行病学等背景因素，IC专家和国家/地区对与AMR相关的风险的认识差异很大。在高流行地区工作的IC专家可能会低估个人风险和集体风险，并可能进一步不利地促进MDRO的传播。