Observational studyClinical infectious diseases : an official publication of the Infectious Diseases Society of America2019
The Differences in Antibiotic Decision-making Between Acute Surgical and Acute Medical Teams: An Ethnographic Study of Culture and Team Dynamics.
Observational study in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 91 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Implementing a Discharge Stewardship Bundle to Improve Antibiotic Use at Transition From Hospital to Home
Using Electronically Derived AutoMated RePOrts of Appropriate Antibiotic Use to Inform SteWardship IntERventions
Who cites it
91 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- European Network for Optimization of Veterinary Antimicrobial Therapy (ENOVAT) 2025 guidelines for surgical antimicrobial prophylaxis in dogs and cats.The Journal of small animal practice · 2026Guideline
- A systematic review and meta-analysis to identify behavioural content and active ingredients of antimicrobial stewardship education and training interventions in hospital-based care settings.Antimicrobial resistance and infection control · 2025Pooled it
- Understanding how veterinarians' knowledge, attitudes, and practices influence antibiotic prescription: a systematic review of survey studies.BMC veterinary research · 2025Pooled it
- Pooled it
- Making microbes matter: evidence for the use of digital storytelling in antimicrobial resistance public engagement.npj antimicrobials and resistance · 2026Article
- The current status and influencing factors of prophylactic antibacterial drug use in patients with hypertriglyceridemic acute pancreatitis.Naunyn-Schmiedeberg's archives of pharmacology · 2026Article
- A qualitative evaluation of a program to implement antimicrobial stewardship for asymptomatic bacteriuria: how site attributes affected uptake.Infection control and hospital epidemiology · 2026Article
- Observational
- Feeling the Vibes: An Investigation Into Resident Antibiotic Prescribing Practices.Open forum infectious diseases · 2026Article
- Patient characteristics, antibiotic use, and in-hospital outcomes in patients with ischaemic colitis: A nationwide retrospective cohort study.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2026Article
- Strategies to improve antimicrobial stewardship in surgery: insights from an ethnographic study.BMJ open · 2026Article
- The influence of traditional food consumption on Cameroonian immigrants' perception of type 2 diabetes in Minnesota: an exploratory qualitative study.Frontiers in public health · 2026Article
- Optimizing Surgical Antibiotic Prophylaxis in the Era of Antimicrobial Resistance: A Position Paper from the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS).Pathogens (Basel, Switzerland) · 2025Review
- Compliance with antimicrobial stewardship guidelines in surgery: an observational, multidisciplinary, cohort study.World journal of emergency surgery : WJES · 2025Observational
- Cultural differences in attitudes towards surgical site infections among French anesthetists and surgeons in digestive surgery in 2022.Antimicrobial resistance and infection control · 2025Article
- Rationalizing antibiotic prescribing for bacterial pneumonia in patients with reported penicillin allergy-a qualitative study.JAC-antimicrobial resistance · 2025Article
- Factors associated with blood culture sampling for adult acute care hospital patients with suspected severe infection: a scoping review using a socioecological framework.JAC-antimicrobial resistance · 2025Review
- Antibiotic Diversity Index: A novel metric to assess antibiotic variation among hospitalized children.Journal of hospital medicine · 2025Article
- Natural History of Preterm Pre-labour Rupture of Membranes in a Singleton Primipara in a Rural Low-Resource Setting in the Absence of Early Antibiotic Intervention: a Case Report.CME journal of clinical case reports · 2025Article
- Handshake antimicrobial stewardship for adult surgical patients.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
31 more citing papers are in PubMed but not listed here.
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Authors and funding
6 authors.
Funding
Abstract
backgroundCultural and social determinants influence antibiotic decision-making in hospitals. We investigated and compared cultural determinants of antibiotic decision-making in acute medical and surgical specialties.
methodsAn ethnographic observational study of antibiotic decision-making in acute medical and surgical teams at a London teaching hospital was conducted (August 2015-May 2017). Data collection included 500 hours of direct observations, and face-to-face interviews with 23 key informants. A grounded theory approach, aided by Nvivo 11 software, analyzed the emerging themes. An iterative and recursive process of analysis ensured saturation of the themes. The multiple modes of enquiry enabled cross-validation and triangulation of the findings.
resultsIn medicine, accepted norms of the decision-making process are characterized as collectivist (input from pharmacists, infectious disease, and medical microbiology teams), rationalized, and policy-informed, with emphasis on de-escalation of therapy. The gaps in antibiotic decision-making in acute medicine occur chiefly in the transition between the emergency department and inpatient teams, where ownership of the antibiotic prescription is lost. In surgery, team priorities are split between 3 settings: operating room, outpatient clinic, and ward. Senior surgeons are often absent from the ward, leaving junior staff to make complex medical decisions. This results in defensive antibiotic decision-making, leading to prolonged and inappropriate antibiotic use.
conclusionsIn medicine, the legacy of infection diagnosis made in the emergency department determines antibiotic decision-making. In surgery, antibiotic decision-making is perceived as a nonsurgical intervention that can be delegated to junior staff or other specialties. Different, bespoke approaches to optimize antibiotic prescribing are therefore needed to address these specific challenges.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.