Clinicians’ Intention to Submit Microbiological Pathogenic Test Before Antibiotics Use and Its Influencing Factors: New Evidence from the Perspective of Hospital Management

Figures & data

Table 1 Variables Distribution of Demographic Factors

Variable	N (%)/Mean±SD
Age	36.56±7.48
Gender
Male	2342 (66.9)
Female	1160 (33.1)
Department
Respiratory department	403 (11.5)
Urological surgical department	375 (10.7)
ICU	520 (14.8)
Neurology department	480 (13.7)
Endocrinology department	354 (10.1)
Orthopedics department	565 (16.1)
Internal medicine department	221 (6.3)
Surgery department	185 (5.3)
Pediatric department	189 (5.4)
Obstetrics and gynecology department	73 (2.1)
Other department	137 (3.9)
Clinical working year	12.01±8.42
Professional title
Senior professional title	118 (3.4)
Associate senior title	650 (18.6)
Middle title	1594 (45.5)
Junior division title	952 (27.2)
Junior professional title	108 (3.1)
No title	80 (2.3)

Table 2 Variables Distribution of Submission Intention and Hospital Management Factors

Variable	N (%)/Mean±SD
Submission intention
Non-restricted-use antibiotics
Yes	2160 (61.7)
Not sure	951 (27.2)
No	391 (11.2)
Restricted-use antibiotics
Yes	3034 (86.6)
Not sure	322 (9.2)
No	146 (4.2)
Special-use antibiotics
Yes	3322 (94.9)
Not sure	94 (2.7)
No	86 (2.5)
Hospital management factors
Training frequency (times per year)
0	173 (4.9)
1	1271 (36.3)
2	1086 (31.0)
3	454 (13.0)
4 at least	518 (14.8)
Publicity frequency (times per year)
0	232 (6.6)
1	1162 (33.2)
2	953 (27.2)
3	411 (11.7)
4 at least	744 (21.2)
Guideline
Yes	2975 (85.0)
No	527 (15.0)
Performance assessment
Yes	2621 (74.8)
No	881 (25.2)
Information decision system
Yes	2959 (84.5)
No	543 (15.5)
Bacterial culture item
Yes	3381 (96.5)
No	121 (3.5)
Fungal culture item
Yes	2738 (78.2)
No	764 (21.8)
Procalcitonin test item
Yes	3291 (94.0)
No	211 (6.0)
Interleukin-6 test item
Yes	1482 (42.3)
No	2020 (57.7)
(1, 3)-β-D-glucan test item
Yes	1397 (39.9)
No	2105 (60.1)

Notes: Training frequency refers to the number of times per year that hospital educates clinicians on specific submission operation norms. Publicity frequency refers to the number of times per year that hospital informs clinicians the importance of submission. Performance assessment refers to hospital with or without performance assessment system on submission. Guideline refers to hospital with or without laboratory service guidelines of the standard operating procedures on submission. Information decision system refers to hospital with or without an information processing scheme to help clinicians decide whether to submit. Laboratory items refer to hospital with or without these laboratory testing items, including bacterial culture item, fungal culture item and so on.

Table 3 Results of Multinomial Logistic Regression on Submission Intention

Variables in the Model: the Base is “No Submission”	Non-Restricted-Use Antibiotics		Restricted-Use Antibiotics		Special-Use Antibiotics
	Submission	Not Sure Submission	Submission	Not Sure Submission	Submission	Not Sure Submission
Guideline: Reference is guideline
No guideline	0.263 (0.188, 0.369)	0.526 (0.375, 0.738)	0.286 (0.174, 0.468)	0.426 (0.244, 0.746)	0.441 (0.209, 0.928)	0.531 (0.205, 1.372)
Performance assessment: Reference is performance assessment
No performance assessment	0.467(0.344, 0.634)	0.791(0.578, 1.083)	0.645(0.396, 1.051)	1.723(1.001, 2.966)	1.294(0.616, 2.715)	1.733(0.704,4.269)
Bacterial culture item: Reference is bacterial culture item
No bacterial culture item	0.141(0.074, 0.268)	0.520(0.292, 0.927)	0.155(0.076, 0.315)	0.092(0.036, 0.232)	0.106(0.046, 0.248)	0.027(0.006,0.117)
Information decision system: Reference is information decision system
No information decision system	1.164(0.813, 1.665)	1.311(0.916, 1.877)	0.467(0.284, 0.766)	0.820(0.473, 1.422)	0.236(0.122, 0.460)	0.182(0.075,0.437)
Procalcitonin test item: Reference is procalcitonin test item
No procalcitonin test item	0.940(0.581, 1.521)	0.695(0.428, 1.129)	0.462(0.246, 0.866)	0.837(0.416, 1.681)	0.443(0.203, 0.966)	0.947(0.357,2.508)
Training frequency (times per year): 4 at least is reference
0	0.499(0.236, 1.058)	0.323(0.145, 0.721)	0.068(0.021, 0.218)	0.195(0.050, 0.759)	0.081(0.018, 0.365)	0.275(0.035,2.187)
1	0.720(0.439, 1.179)	0.772(0.454, 1.315)	0.155(0.063, 0.381)	0.313(0.112, 0.877)	0.649(0.194, 2.171)	0.734(0.132,4.084)
2	1.197(0.722, 1.986)	1.493(0.869, 2.563)	0.319(0.125, 0.814)	0.550(0.189, 1.598)	1.348(0.374, 4.861)	0.944(0.157,5.660)
3	2.441(1.314, 4.534)	2.185(1.142, 4.180)	0.579(0.192, 1.752)	0.607(0.174, 2.119)	2.640(0.442, 15.770)	1.705(0.179,16.229)
Publicity frequency(times per year): 4 at least is reference
0	0.900(0.476, 1.701)	1.641(0.847, 3.179)	3.885(1.556, 9.696)	1.771(0.601, 5.220)	1.418(0.359, 5.606)	5.940(0.831,42.441)
1	1.892(1.203, 2.975)	2.724(1.672, 4.438)	3.749(1.997, 7.040)	3.291(1.544, 7.016)	1.531(0.511, 4.589)	6.734(1.297,34.979)
2	1.456(0.909, 2.313)	2.176(1.317, 3.596)	2.310(1.171, 4.557)	1.911(0.852, 4.287)	0.753(0.243, 2.331)	3.534(0.658,18.973)
3	0.772(0.454, 1.313)	1.610(0.927, 2.797)	1.689(0.704, 4.053)	2.073(0.766, 5.610)	0.772(0.191, 3.121)	3.014(0.447,20.319)
Fungal culture item: Reference is fungal culture item
No fungal culture item	1.210(0.861, 1.700)	1.092(0.770, 1.549)	1.004(0.573, 1.759)	0.973(0.528, 1.793)	0.713(0.340, 1.496)	1.268(0.534,3.013)
(1, 3)-β-D-glucan test item: Reference is (1, 3)-β-D-glucan test item
No (1, 3)-β-D-glucan test item	0.842(0.620, 1.144)	1.388(1.004, 1.917)	1.818(1.100, 3.005)	2.447(1.379, 4.343)	2.186(1.062, 4.497)	5.013(1.891,13.292)
Interleukin-6 test item: Reference is interleukin-6 test item
No interleukin-6 test item	0.953(0.704, 1.289)	1.201(0.875, 1.649)	1.088(0.658, 1.798)	2.086(1.175, 3.705)	0.776(0.368, 1.634)	1.163(0.452,2.990)

Notes: Statistically significant results (p < 0.05) are in boldface.

Abbreviations: AR, antimicrobial resistance; submission intention, clinicians’ intention to submit microbiological pathogenic test; OECD, Organization for Economic Cooperation and Development; CDC, Centers for Disease Control; QCC, quality control circle; APP, application; GLASS, Antimicrobial Resistance and Use; ASP, antimicrobial stewardship program.