Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study

Background: The objective of the present study was to describe the knowledge regarding the antibiotic therapy of students of three medical schools in Medellín, Colombia. Methods: The study population comprised medical students who were enrolled in three universities. The instrument contained questio...

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Autores:: Higuita Gutiérrez, Luis Felipe
Molina García, Valentina
Acevedo Guiral, Jenifer
Roncancio Villamil, Gustavo Eduardo
Jiménez Quiceno, Judy Natalia

Tipo de recurso:: Article of journal

Fecha de publicación:: 2020

Institución:: Universidad Cooperativa de Colombia

Repositorio:: Repositorio UCC

Idioma:

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repository_id_str
dc.title.spa.fl_str_mv	Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study
title	Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study
spellingShingle	Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study Antibiotic resistance Education medical Prescription drug misuse
title_short	Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study
title_full	Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study
title_fullStr	Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study
title_full_unstemmed	Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study
title_sort	Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study
dc.creator.fl_str_mv	Higuita Gutiérrez, Luis Felipe Molina García, Valentina Acevedo Guiral, Jenifer Roncancio Villamil, Gustavo Eduardo Jiménez Quiceno, Judy Natalia
dc.contributor.author.none.fl_str_mv	Higuita Gutiérrez, Luis Felipe Molina García, Valentina Acevedo Guiral, Jenifer Roncancio Villamil, Gustavo Eduardo Jiménez Quiceno, Judy Natalia
dc.subject.spa.fl_str_mv	Antibiotic resistance Education medical Prescription drug misuse
topic	Antibiotic resistance Education medical Prescription drug misuse
description	Background: The objective of the present study was to describe the knowledge regarding the antibiotic therapy of students of three medical schools in Medellín, Colombia. Methods: The study population comprised medical students who were enrolled in three universities. The instrument contained questions regarding their current academic term, the university, the perceived quality of the education received on antibiotic therapy and bacterial resistance, and specific questions on upper respiratory tract infections, pneumonia, urinary tract infections, and skin and soft tissue infections. The information was analyzed by calculating frequencies and measures of dispersion and central tendency. Knowledge regarding the treatment for each type of infection was compared using the Mann–Whitney U test and the Kruskal–Wallis H test. Results: We included 536 medical students, of which 43.5% students consider that the university has not sufficiently trained them to interpret antibiograms and 29.6% students consider that the quality of information received on the subject at their university ranges from regular to poor. The mean score for knowledge regarding antibiotic therapy for upper respiratory tract infections was 44.2 (9.9) on a scale from 0 to 100. The median score with regard to the treatment of pneumonia was 52.9 (14.7), that of urinary tract infection was 58.7 (14.8), and that of skin and soft tissue infections was 63.1 (19.4). The knowledge regarding antibiotic therapy for upper respiratory tract infections, pneumonia, and urinary tract infection does not improve with the academic term, the university, or perceived quality of the education received. Conclusion: A large proportion of medical students perceive that the training received from the university is insufficient with regard to antibiotic use and bacterial resistance, which is consistent with the limited knowledge reflected in the selection of antibiotic treatment for respiratory, urinary tract, and skin and soft tissue infections. Overall, the situation was identical among all universities, and it did not significantly increase with the completion of an academic term.
publishDate	2020
dc.date.accessioned.none.fl_str_mv	2020-02-11T20:41:32Z
dc.date.available.none.fl_str_mv	2020-02-11T20:41:32Z
dc.date.issued.none.fl_str_mv	2020-01-28
dc.type.none.fl_str_mv	Artículo
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dc.identifier.issn.spa.fl_str_mv	1472-6920
dc.identifier.uri.spa.fl_str_mv	https://doi.org/10.1186/s12909-020-1934-y
dc.identifier.uri.none.fl_str_mv	https://hdl.handle.net/20.500.12494/16740
dc.identifier.bibliographicCitation.spa.fl_str_mv	Higuita-Gutiérrez, L.F., Molina -Garcia, V., Acevedo Guiral, J. et al. Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study. BMC Med Educ 20, 22 (2020). https://doi.org/10.1186/s12909-020-1934-y
identifier_str_mv	1472-6920 Higuita-Gutiérrez, L.F., Molina -Garcia, V., Acevedo Guiral, J. et al. Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study. BMC Med Educ 20, 22 (2020). https://doi.org/10.1186/s12909-020-1934-y
url	https://doi.org/10.1186/s12909-020-1934-y https://hdl.handle.net/20.500.12494/16740
dc.relation.isversionof.spa.fl_str_mv	https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-020-1934-y
dc.relation.ispartofjournal.spa.fl_str_mv	BMC Medical Education
dc.relation.references.spa.fl_str_mv	Chandel NS, Budinger GR. The good and the bad of antibiotics. Sci Transl Med. 2013;5:192fs25. https://doi.org/10.1126/scitranslmed.3006567. Laxminarayan R, Matsoso P, Pant S, Brower C, Barter D, Klugman K, et al. Access to effective antimicrobials: a worldwide challenge. Lancet. 2015;387:168–75. https://doi.org/10.1016/S0140-6736(15)00474-2. World Health Organization. Antibiotic resistance. 2018. [Citado 2019 mar 15]. Disponible en: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance. Cecchini M, Langer J, Slawomirski L. Antimicrobial Resistance in G7 Countries and Beyond: Economic Issues, Policies and Options for Action. Paris: Organization for Economic Co-operation and Development; 2015. p. 1–75. Alanis AJ. Resistance to antibiotics: are we in the post-antibiotic era? Arch Med Res. 2005;36:697–705. https://doi.org/10.1016/j.arcmed.2005.06.009. Simpson SA, Wood F, Butler CC. General practitioners' perceptions of antimicrobial resistance: a qualitative study. J Antimicrob Chemother. 2007;59(2):292–6. https://doi.org/10.1093/jac/dkl467. Chua K-P, Fischer MA, Linder JA. Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study. BMJ. 2019;364:k5092. https://doi.org/10.1136/bmj.k5092. Alanazi MQ, Al-Jeraisy MI, Salam M. Prevalence and predictors of antibiotic prescription errors in an emergency department, Central Saudi Arabia. Drug Healthcare Patient Saf. 2015;7:1–9. https://doi.org/10.2147/DHPS.S83770. Cortes JA, Montenegro-Morillo L. Encuesta de conocimientos, actitudes y prácticas sobre el uso de antibióticos en médicos colombianos. Infectio. 2018;22:94. https://doi.org/10.22354/in.v22i2.714. World Health Organization. The evolving threat of antimicrobial resistance—options for action. 2012. [citado 2019 mar 15]. Disponible en: http://whqlibdoc.who.int/publications/2012/9789241503181_eng.pdf. Abbo LM, Cosgrove SE, Pottinger PS, Pereyra M, Sinkowitz-Cochran R, Srinivasan A, et al. Medical students' perceptions and knowledge about antimicrobial stewardship: how are we educating our future prescribers? Clin Infect Dis. 2013;57:631–8. https://doi.org/10.1093/cid/cit370. Article Sánchez D, Dyar OJ, Del Pozo JL, Amiguet JA, Colmenero JD, Fariñas MD, et al. La formación de grado en enfermedades infecciosas, resistencia y uso de antibióticos desde la perspectiva de los estudiantes de Medicina. Enfermedades Infecciosas y Microbiologia Clinica. 2019;37:25–30. https://doi.org/10.1016/j.eimc.2017.12.003. Dyar OJ, Pulcini C, Howard P, Nathwani D, ESGAP (ESCMID study Group for Antibiotic Policies). European medical students: a first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. J Antimicrob Chemother. 2014;69:842–6. https://doi.org/10.1093/jac/dkt440. Yang K, Wu D, Tan F, Shi S, Guo X, Min Q, et al. Attitudes and perceptions regarding antimicrobial use and resistance among medical students in Central China. SpringerPlus. 2016;5:1779. https://doi.org/10.1186/s40064-016-3454-0. Canton R. Lectura interpretada del antibiograma: una necesidad clínica. Elservier Clínica. 2010;28:375–85. https://doi.org/10.1016/j.eimc.2010.01.001. Butt AA, Navasero CS, Thomas B, Al Marri S, Al Katheeri H, Al Thani A, et al. Antibiotic prescription patterns for upper respiratory tract infections in the outpatient Qatari population in the private sector. Int J Infect Dis. 2017;55:20–3. https://doi.org/10.1016/j.ijid.2016.12.004. Schroeck JL, Ruh CA, Sellick JA Jr, Ott MC, Mattappallil A, Mergenhagen KA. Factors associated with antibiotic misuse in outpatient treatment for upper respiratory tract infections. Antimicrob Agents Chemother. 2015;59:3848–52. https://doi.org/10.1128/AAC.00652-15. Harakeh S, Almatrafi M, Ungapen H, Hammad R, Olayan F, Hakim R, et al. Perceptions of medical students towards antibiotic prescribing for upper respiratory tract infections in Saudi Arabia. BMJ Open Respir Res. 2015;2:e000078. https://doi.org/10.1136/bmjresp-2014-000078. Instituto Nacional de Salud. Protocolo de vigilancia en Salud Pública. Infección respiratoria aguda (IRA). 2017. [citado 2019 Mar 15]. Disponible en: http://www.saludpereira.gov.co/medios/IRA_PROTOCOLO2017.pdf. Blanquer J, Sanz F. Neumonía adquirida en la comunidad. Arch Bronconeumol. 2010;46:26–30. https://doi.org/10.1016/S0300-2896(10)70043-0. Canbaz S, Peksen Y, Sunter AT, Leblebicioglu H, Sunbul M. Antibiotic prescribing and urinary tract infection. Int J Antimicrob Agents. 2002;20:407–11. https://doi.org/10.1016/S0924-8579(02)00252-2. Sekikubo M, Hedman K, Mirembe F, Brauner A. Antibiotic overconsumption in pregnant women with urinary tract symptoms in Uganda. Clin Infect Dis. 2017;65:544. https://doi.org/10.1093/cid/cix356. Khoshnood S, Heidary M, Mirnejad R, Bahramian A, Sedighi M, Mirzaei H, et al. Drug-resistant gram-negative uropathogens: a review. Biomed Pharmacother. 2017;94:982–94. https://doi.org/10.1016/j.biopha.2017.08.006. Tandogdu Z, Wagenlehner FM. Global epidemiology of urinary tract infections. Curr Opin Infect Dis. 2016;29:73–9. https://doi.org/10.1097/QCO.0000000000000228. Mazzariol A, Bazaj A, Cornaglia G. Multidrug-resistant gram-negative bacteria causing urinary tract infections: a review. J Chemother. 2017;29:2–9. https://doi.org/10.1080/1120009X.2017.1380395. Edelsberg J, Taneja C, Zervos M, Haque N, Moore C, Reyes K, et al. Trends in US hospital admissions for skin and soft tissue infections. Emerg Infect Dis. 2009;15:1516–8. https://doi.org/10.3201/eid1509.081228. Tabaqchali S. Vancomycin-resistant Staphylococcus aureus: apocalypse now? Lancet. 1997;350:1644–5. https://doi.org/10.1016/S0140-6736(05)64269-9. Butler C, Simpson S, Dunstan F, Rollnick S, Cohen D, Gillespie D. Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial. BMJ. 2012;344:d8173. https://doi.org/10.1136/bmj.d8173. Park S, Soumerai SB, Adams AS, Finkelstein JA, Jang S, Ross-Degnan D. Antibiotic use following a Korean national policy to prohibit medication dispensing by physicians. Health Policy Plan. 2005;20:302–9. https://doi.org/10.1093/heapol/czi033. Sadsad R, Sintchenko V, McDonnell GD, Gilbert GL. Effectiveness of hospital-wide methicillin-resistant Staphylococcus aureus (MRSA) infection control policies differs by ward specialty. PLoS One. 2013;8:e83099. https://doi.org/10.1371/journal.pone.0083099. Ohl CA, Luther VP. Health care provider education as a tool to enhance antibiotic stewardship practices. Infect Dis Clin N Am. 2014;28:177–93. https://doi.org/10.1016/j.idc.2014.02.001. Hsu JL. Building an Antibiotic Stewardship Program: An Interactive Teaching Module for Medical Students. MedEdPORTAL. 2018;14:10726. https://doi.org/10.15766/mep_2374-8265.10726. MacDougall C, Schwartz BS, Kim L. An interprofessional curriculum on antimicrobial stewardship improves knowledge and attitudes toward appropriate antimicrobial use and collaboration. Open Forum Infect Dis. 2017;4:ofw225. doi:https://doi.org/10.1093/ofid/ofw225. De Vries TPGM, Henning RH, Hogerzeil HV, Fresle DF. Guide to good prescribing. Geneva: World Health Organization; 1994. Shankar PR, Palaian S, Gyawali S, Mishra P, Mohan L. Personal drug selection: problem-based learning in pharmacology: experience from a medical School in Nepal. PLoS One. 2007;2:e524. https://doi.org/10.1371/journal.pone.0000524. Kawakami J, Mimura Y, Adachi I, Takeguchi N. Application of personal drug (P-drug) seminar to clinical pharmacy education in the graduate school of pharmaceutical sciences. Yakugaku Zasshi. 2002;122:819–29. https://doi.org/10.1248/yakushi.122.819. Silverberg SL, Zannella VE, Countryman D, Ayala AP, Lenton E, Friesen F, et al. A review of antimicrobial stewardship training in medical education. Int J Med Educ. 2017;8:353–74. https://doi.org/10.5116/ijme.59ba.2d47.
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spelling	Higuita Gutiérrez, Luis FelipeMolina García, ValentinaAcevedo Guiral, JeniferRoncancio Villamil, Gustavo EduardoJiménez Quiceno, Judy Natalia202020-02-11T20:41:32Z2020-02-11T20:41:32Z2020-01-281472-6920https://doi.org/10.1186/s12909-020-1934-yhttps://hdl.handle.net/20.500.12494/16740Higuita-Gutiérrez, L.F., Molina -Garcia, V., Acevedo Guiral, J. et al. Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study. BMC Med Educ 20, 22 (2020). https://doi.org/10.1186/s12909-020-1934-yBackground: The objective of the present study was to describe the knowledge regarding the antibiotic therapy of students of three medical schools in Medellín, Colombia. Methods: The study population comprised medical students who were enrolled in three universities. The instrument contained questions regarding their current academic term, the university, the perceived quality of the education received on antibiotic therapy and bacterial resistance, and specific questions on upper respiratory tract infections, pneumonia, urinary tract infections, and skin and soft tissue infections. The information was analyzed by calculating frequencies and measures of dispersion and central tendency. Knowledge regarding the treatment for each type of infection was compared using the Mann–Whitney U test and the Kruskal–Wallis H test. Results: We included 536 medical students, of which 43.5% students consider that the university has not sufficiently trained them to interpret antibiograms and 29.6% students consider that the quality of information received on the subject at their university ranges from regular to poor. The mean score for knowledge regarding antibiotic therapy for upper respiratory tract infections was 44.2 (9.9) on a scale from 0 to 100. The median score with regard to the treatment of pneumonia was 52.9 (14.7), that of urinary tract infection was 58.7 (14.8), and that of skin and soft tissue infections was 63.1 (19.4). The knowledge regarding antibiotic therapy for upper respiratory tract infections, pneumonia, and urinary tract infection does not improve with the academic term, the university, or perceived quality of the education received. Conclusion: A large proportion of medical students perceive that the training received from the university is insufficient with regard to antibiotic use and bacterial resistance, which is consistent with the limited knowledge reflected in the selection of antibiotic treatment for respiratory, urinary tract, and skin and soft tissue infections. Overall, the situation was identical among all universities, and it did not significantly increase with the completion of an academic term.Background: The objective of the present study was to describe the knowledge regarding the antibiotic therapy of students of three medical schools in Medellín, Colombia. Methods: The study population comprised medical students who were enrolled in three universities. The instrument contained questions regarding their current academic term, the university, the perceived quality of the education received on antibiotic therapy and bacterial resistance, and specific questions on upper respiratory tract infections, pneumonia, urinary tract infections, and skin and soft tissue infections. The information was analyzed by calculating frequencies and measures of dispersion and central tendency. Knowledge regarding the treatment for each type of infection was compared using the Mann–Whitney U test and the Kruskal–Wallis H test. Results: We included 536 medical students, of which 43.5% students consider that the university has not sufficiently trained them to interpret antibiograms and 29.6% students consider that the quality of information received on the subject at their university ranges from regular to poor. The mean score for knowledge regarding antibiotic therapy for upper respiratory tract infections was 44.2 (9.9) on a scale from 0 to 100. The median score with regard to the treatment of pneumonia was 52.9 (14.7), that of urinary tract infection was 58.7 (14.8), and that of skin and soft tissue infections was 63.1 (19.4). The knowledge regarding antibiotic therapy for upper respiratory tract infections, pneumonia, and urinary tract infection does not improve with the academic term, the university, or perceived quality of the education received. Conclusion: A large proportion of medical students perceive that the training received from the university is insufficient with regard to antibiotic use and bacterial resistance, which is consistent with the limited knowledge reflected in the selection of antibiotic treatment for respiratory, urinary tract, and skin and soft tissue infections. Overall, the situation was identical among all universities, and it did not significantly increase with the completion of an academic term.https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001501791https://orcid.org/0000-0003-1361-3124https://scienti.minciencias.gov.co/gruplac/jsp/visualiza/visualizagr.jsp?nro=00000000011355luis.higuita@campusucc.edu.co9Universidad Cooperativa de Colombia, Facultad de Ciencias de la Salud, Medicina, Medellín y EnvigadoMedicinaMedellínhttps://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-020-1934-yBMC Medical EducationChandel NS, Budinger GR. The good and the bad of antibiotics. Sci Transl Med. 2013;5:192fs25. https://doi.org/10.1126/scitranslmed.3006567.Laxminarayan R, Matsoso P, Pant S, Brower C, Barter D, Klugman K, et al. Access to effective antimicrobials: a worldwide challenge. Lancet. 2015;387:168–75. https://doi.org/10.1016/S0140-6736(15)00474-2.World Health Organization. Antibiotic resistance. 2018. [Citado 2019 mar 15]. Disponible en: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance.Cecchini M, Langer J, Slawomirski L. Antimicrobial Resistance in G7 Countries and Beyond: Economic Issues, Policies and Options for Action. Paris: Organization for Economic Co-operation and Development; 2015. p. 1–75.Alanis AJ. Resistance to antibiotics: are we in the post-antibiotic era? Arch Med Res. 2005;36:697–705. https://doi.org/10.1016/j.arcmed.2005.06.009.Simpson SA, Wood F, Butler CC. General practitioners' perceptions of antimicrobial resistance: a qualitative study. J Antimicrob Chemother. 2007;59(2):292–6. https://doi.org/10.1093/jac/dkl467.Chua K-P, Fischer MA, Linder JA. Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study. BMJ. 2019;364:k5092. https://doi.org/10.1136/bmj.k5092.Alanazi MQ, Al-Jeraisy MI, Salam M. Prevalence and predictors of antibiotic prescription errors in an emergency department, Central Saudi Arabia. Drug Healthcare Patient Saf. 2015;7:1–9. https://doi.org/10.2147/DHPS.S83770.Cortes JA, Montenegro-Morillo L. Encuesta de conocimientos, actitudes y prácticas sobre el uso de antibióticos en médicos colombianos. Infectio. 2018;22:94. https://doi.org/10.22354/in.v22i2.714.World Health Organization. The evolving threat of antimicrobial resistance—options for action. 2012. [citado 2019 mar 15]. Disponible en: http://whqlibdoc.who.int/publications/2012/9789241503181_eng.pdf.Abbo LM, Cosgrove SE, Pottinger PS, Pereyra M, Sinkowitz-Cochran R, Srinivasan A, et al. Medical students' perceptions and knowledge about antimicrobial stewardship: how are we educating our future prescribers? Clin Infect Dis. 2013;57:631–8. https://doi.org/10.1093/cid/cit370. ArticleSánchez D, Dyar OJ, Del Pozo JL, Amiguet JA, Colmenero JD, Fariñas MD, et al. La formación de grado en enfermedades infecciosas, resistencia y uso de antibióticos desde la perspectiva de los estudiantes de Medicina. Enfermedades Infecciosas y Microbiologia Clinica. 2019;37:25–30. https://doi.org/10.1016/j.eimc.2017.12.003.Dyar OJ, Pulcini C, Howard P, Nathwani D, ESGAP (ESCMID study Group for Antibiotic Policies). European medical students: a first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. J Antimicrob Chemother. 2014;69:842–6. https://doi.org/10.1093/jac/dkt440.Yang K, Wu D, Tan F, Shi S, Guo X, Min Q, et al. Attitudes and perceptions regarding antimicrobial use and resistance among medical students in Central China. SpringerPlus. 2016;5:1779. https://doi.org/10.1186/s40064-016-3454-0.Canton R. Lectura interpretada del antibiograma: una necesidad clínica. Elservier Clínica. 2010;28:375–85. https://doi.org/10.1016/j.eimc.2010.01.001.Butt AA, Navasero CS, Thomas B, Al Marri S, Al Katheeri H, Al Thani A, et al. Antibiotic prescription patterns for upper respiratory tract infections in the outpatient Qatari population in the private sector. Int J Infect Dis. 2017;55:20–3. https://doi.org/10.1016/j.ijid.2016.12.004.Schroeck JL, Ruh CA, Sellick JA Jr, Ott MC, Mattappallil A, Mergenhagen KA. Factors associated with antibiotic misuse in outpatient treatment for upper respiratory tract infections. Antimicrob Agents Chemother. 2015;59:3848–52. https://doi.org/10.1128/AAC.00652-15.Harakeh S, Almatrafi M, Ungapen H, Hammad R, Olayan F, Hakim R, et al. Perceptions of medical students towards antibiotic prescribing for upper respiratory tract infections in Saudi Arabia. BMJ Open Respir Res. 2015;2:e000078. https://doi.org/10.1136/bmjresp-2014-000078.Instituto Nacional de Salud. Protocolo de vigilancia en Salud Pública. Infección respiratoria aguda (IRA). 2017. [citado 2019 Mar 15]. Disponible en: http://www.saludpereira.gov.co/medios/IRA_PROTOCOLO2017.pdf.Blanquer J, Sanz F. Neumonía adquirida en la comunidad. Arch Bronconeumol. 2010;46:26–30. https://doi.org/10.1016/S0300-2896(10)70043-0.Canbaz S, Peksen Y, Sunter AT, Leblebicioglu H, Sunbul M. Antibiotic prescribing and urinary tract infection. Int J Antimicrob Agents. 2002;20:407–11. https://doi.org/10.1016/S0924-8579(02)00252-2.Sekikubo M, Hedman K, Mirembe F, Brauner A. Antibiotic overconsumption in pregnant women with urinary tract symptoms in Uganda. Clin Infect Dis. 2017;65:544. https://doi.org/10.1093/cid/cix356.Khoshnood S, Heidary M, Mirnejad R, Bahramian A, Sedighi M, Mirzaei H, et al. Drug-resistant gram-negative uropathogens: a review. Biomed Pharmacother. 2017;94:982–94. https://doi.org/10.1016/j.biopha.2017.08.006.Tandogdu Z, Wagenlehner FM. Global epidemiology of urinary tract infections. Curr Opin Infect Dis. 2016;29:73–9. https://doi.org/10.1097/QCO.0000000000000228.Mazzariol A, Bazaj A, Cornaglia G. Multidrug-resistant gram-negative bacteria causing urinary tract infections: a review. J Chemother. 2017;29:2–9. https://doi.org/10.1080/1120009X.2017.1380395.Edelsberg J, Taneja C, Zervos M, Haque N, Moore C, Reyes K, et al. Trends in US hospital admissions for skin and soft tissue infections. Emerg Infect Dis. 2009;15:1516–8. https://doi.org/10.3201/eid1509.081228.Tabaqchali S. Vancomycin-resistant Staphylococcus aureus: apocalypse now? 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Application of personal drug (P-drug) seminar to clinical pharmacy education in the graduate school of pharmaceutical sciences. Yakugaku Zasshi. 2002;122:819–29. https://doi.org/10.1248/yakushi.122.819.Silverberg SL, Zannella VE, Countryman D, Ayala AP, Lenton E, Friesen F, et al. A review of antimicrobial stewardship training in medical education. 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Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study

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