International Urology and Nephrology

, Volume 49, Issue 8, pp 1311–1318 | Cite as

Impact of the medical specialty on knowledge regarding multidrug-resistant organisms and strategies toward antimicrobial stewardship

  • Steffen LebentrauEmail author
  • Christian Gilfrich
  • Malte W. Vetterlein
  • Harald Schumacher
  • Philipp J. Spachmann
  • Sabine D. Brookman-May
  • Hans M. Fritsche
  • Martin Schostak
  • Florian M. Wagenlehner
  • Maximilian Burger
  • Matthias May
  • MR2 study group
Urology - Original Paper



Evidence is scarce on subject-specific knowledge of multidrug-resistant organisms and rational use of antibiotics. We aimed at evaluating attitude, perception, and knowledge about multidrug-resistant organisms (MDRO) and antibiotic prescribing among urologists versus other medical specialties.


Within the MR2-study (Multiinstitutional Reconnaissance of practice with MultiResistant bacteria), a questionnaire was conducted targeting general surgeons, internists, gynecologists, and urologists in 18 German hospitals. The influence of medical specialty on predetermined endpoints was assessed by multivariable logistic regression models.


With 456 evaluable questionnaires, the response rate was 43% (456/1061). Within seven workdays prior to survey, urologists prescribed antibiotics to >5 patients more often than non-urologists (50.7 vs. 24.3%; p < 0.001). Urologists were more confident regarding dosage, frequency, and duration of antibiotic treatment (p = 0.038) as well as in interpreting antibiograms (p < 0.001). Both urologists and non-urologists had poor knowledge about antibiotic stewardship. Urologists were more confident regarding local resistance patterns (p < 0.001). However, local rates of ciprofloxacin-resistant E. coli strains were correctly categorized by only 36.3 and 31.2% of urologists and non-urologists, respectively (p = 0.168). Compared to non-urologists, urologists more often acknowledged the use of broad-spectrum antibiotic agents as a problem, potentially resulting in increased resistance pattern (p = 0.036). Conversely, 31.5 and 30.7% of urologists and non-urologists (p = 0.424), respectively, would prescribe broad-spectrum antibiotics to a female patient with an uncomplicated urinary tract infection. Urologists did not attend more training courses regarding multidrug-resistance or antibiotic prescribing and did not perceive a better quality of discharge letters regarding MDRO.


There is substantial need for advanced training regarding MDRO and antibiotic stewardship, regardless of medical specialty.


Antibiotic resistance Antibiotic stewardship Knowledge Multidrug-resistant organisms Questionnaire Urology 



We would like to thank our colleagues from the following hospitals for participating in the MR2 study: Barmherzige Brüder Hospitals Munich, Regensburg and Straubing, Biberach Hospital, Carl-Thiem Klinikum Cottbus, Clinic Dortmund, Frankfurt/Oder Hospital, Garmisch-Partenkirchen Hospital, University Clinic Gießen, Hameln Hospital, University Medical Center Magdeburg, University Medical Center of the Technical University Munich, Nauen Hospital, Ruppiner Kliniken and Brandenburg Medical School, Pegnitz Hospital, Caritas St. Josef Medical Center Regensburg, Kliniken Nordoberpfalz, Weiden.

MR2 study group collaborators

Sabine Beiser, Jörg Bernhardt, Thomas Bschleipfer, Özden Dirik, Johannes Geiss, Katharina Hauner, Bernd Hoschke, Thomas Karl, Andreas Kestler, Theodor Klotz, Christian Kuhl, Mike Lehsnau, Arno Macht, Giuseppe Magistro, Odilo Maurer, Alexander Novotny, Ulrike Necknig, Robert Obermaier, Soeren Promnitz, Margitta Retz, Christoph Scheu, Carsten Scholz, Christian G. Stief, Michael Truß.

Compliance with ethical standards

Conflict of interest

F. Wagenlehner has served as a paid consultant for Achaogen, Astellas, AstraZeneca, Bionorica, Cubist, Galenus, GSK, Janssen, Leo-Pharma, Merlion, MSD, OM-Pharma, Pierre Fabre, Rosen Pharma, and Zambon, has received payment for presenting at continuing medical education events from Astellas, AstraZeneca, Bionorica Cubist, Galenus, Leo-Pharma, Merlion, MSD, OM-Pharma, Pierre Fabre, Rosen Pharma, and Zambon, has also received payment for carrying out clinical trials on behalf of Achaogen, Astellas, AstraZeneca, Bionorica, Calixa, Cerexa, Cubist, The German Research Foundation (Deutsche Forschungsgemeinschaft), the European Association of Urology, Galenus, The Hessen State Ministry of Higher Education, Research and the Arts, Merlion, OM-Pharma, Rosen Pharma, and Zambon. S. Brookman-May is an employee of Janssen Pharma Research and Development (Director Clinical Research Oncology) at time of study design, conduct, and analysis. The other authors have no conflicts to report.

Ethical standard

We affirm that all authors have complied with the principles of International Urology and Nephrology regarding ethical responsibilities of authors and compliance with ethical standards.


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Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Steffen Lebentrau
    • 1
    Email author
  • Christian Gilfrich
    • 2
  • Malte W. Vetterlein
    • 3
  • Harald Schumacher
    • 2
  • Philipp J. Spachmann
    • 4
  • Sabine D. Brookman-May
    • 5
  • Hans M. Fritsche
    • 4
  • Martin Schostak
    • 6
  • Florian M. Wagenlehner
    • 7
  • Maximilian Burger
    • 4
  • Matthias May
    • 2
  • MR2 study group
  1. 1.Department of Urology and Pediatric Urology, Brandenburg Medical SchoolRuppiner KlinikenNeuruppinGermany
  2. 2.Department of UrologySt. Elisabeth HospitalStraubingGermany
  3. 3.Department of UrologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  4. 4.Department of Urology, Caritas St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
  5. 5.Department of UrologyLMU MunichMunichGermany
  6. 6.Department of Urology and Pediatric Urology, Magdeburg University Medical CenterOtto-von-Guericke UniversityMagdeburgGermany
  7. 7.Department of Urology, Pediatric Urology and AndrologyJustus-Liebig UniversityGiessenGermany

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