A new antibiotic stewardship program approach is effective on inappropriate surgical prophylaxis and discharge prescription

Abstract

Introduction: This study aims to evaluate the efficacy of a new antimicrobial stewardship program (ASP) on surgical antibiotic prophylaxis (SP) and antibiotics in discharge prescriptions used as a continuation of SP.
 Methodology: The study included elective patients with clean and clean-contaminated wounds. The accuracy of the assigned SP was evaluated according to international guidelines. Primary outcome measures comprised appropriateness of prophylactic antibiotic indication, correct timing of initial dose, discontinuation of SP within 24 hours, and antibiotic prescription at discharge. A secondary outcome measure was to determine whether the effect of ASP was sustained long-term.
 Results: The total compliance rate for all stages of SP increased from 8% to 52.1% after the intervention (p < 0.05). When analyzed according to individual SP components, it was found that although ASP did not change first dose timing rates, it did affect the rates of prophylactic antibiotic indication, discontinuation of SP within 24 hours and antibiotic prescription at discharge, with statistical significance (p < 0.05). In addition, ASP continued to increase its effectiveness throughout the 3rd year.
 Conclusions: Based on the findings of our study, it seems clear that the modified ASP introduced in our general surgery clinic can be used effectively and simply; in addition, this ASP increases its efficacy with time.

Assessment of prophylactic antibiotic usage habits of the general surgeons in Turkey

“…Among these, Urgancı et al [20] claimed that 88.5% of discharge prescriptions contained antibiotics, whereas Karaali et al reported that surgeons reduced their prescription rates from 80.6% to 9.4%. after the introduction of a modified ASP method [21]. All these data indicate that antibiotics are used at differing rates in prescriptions of patients being discharged in Turkey, and support our opinion that this data should be included when calculating total compliance to SP.…”

Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research

“…Leadership engagement refers to the degree to which leaders are committed to, involved in, and held accountable for the implementation of interventions. In 21 studies, the involvement and support of higher-level stakeholders (such as officials from the Ministry of Health, health authorities, experts, leaders in health facilities) and administrative staff were reported as a common facilitator for the successful implementation of behavior change interventions [ 37 , 39 , 40 , 44 , 48 – 50 , 52 , 54 , 56 , 58 , 59 , 62 , 65 , 70 , 78 – 83 ]. The lack thereof had been documented to impede intervention implementation in seven studies [ 43 , 46 , 60 , 63 , 69 , 71 , 84 ].…”

“…The individual stage of change was addressed in 11 studies as a barrier to changing prescribing practice [ 40 , 41 , 49 , 59 , 60 , 63 , 66 , 68 , 69 , 71 , 75 ]. Prescribers sometimes were reluctant or even resistant to change their habitual practice, because they were skeptical about the effectiveness of the interventions.…”

“…In practice, researchers commonly maintained good communication with stakeholders during the implementation process, such as holding regular meetings for updating the progress or conducting interviews or workshops to understand their interests and needs. Participatory approaches, which involve stakeholders in shared decision-making, were also commonly adopted in the reviewed studies and current literature on implementation research [ 50 , 59 , 82 , 104 , 105 ]. In addition to decision-makers, we found that involving target populations in the development of behavior change interventions was helpful in identifying participants’ needs and concerns, raising their awareness and knowledge about the interventions, and ensuring that the developed tools and protocols were user-friendly and could be incorporated into routine practice, hence solving the implementation challenges identified in the reviewed studies.…”

Review of the Appropriateness of Surgical Antimicrobial Prophylaxis

“…Moreover, Anandalwar et al reported that regarding the use of surgical antibiotic prophylaxis in general pediatric surgery, 44% of the cases received inappropriate prophylaxis, of which 42% were considered overtreatment and 58% were considered undertreatment [14]. Karaali et al found that in the pre-intervention phase of their study, the rate at which all stages of surgical prophylaxis were adhered to was found to be low [15].…”