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.

Keywords: Antimicrobial  resistance; Carbapenemase-producing Acinetobacter baumannii;  Carbapenemase-producing Enterobacteriaceae; Carbapenemase-producing  Pseudomonas aeruginosa; Europe; Infection prevention and control;  Meticillin-resistant Staphylococcus aureus; Risk perception;  Vancomycin-resistant Enterococci.