Collaborative Antimicrobial Stewardship for Surgeons

Robinson, Evan D; Volles, David F.; Kramme, Katherine; Mathers, Amy J; Sawyer, Robert G.

doi:10.1016/j.idc.2019.11.002

Cited by 7 publications

(5 citation statements)

References 32 publications

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“…In our case, given that the source was unknown and there were no localizing symptoms for the underlying source of the bacteria, we collaborated with the infectious disease physicians for culture-directed antibiotic stewardship and further work-up to rule out distant, occult primary sources of sepsis such as infective endocarditis and septic arthritis. These also proved to be negative in our patient [ 19 , 20 ].…”

Section: Discussionsupporting

confidence: 51%

Primary Peritonitis Secondary to Streptococcus pyogenes in a Young Female Adult—A Case Report and Literature Review

Lee

Tay

2021

Infectious Disease Reports

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Primary spontaneous bacterial peritonitis (SBP) is a rare cause of acute abdomen in previously healthy patients, even more unusually caused by a group A Streptococcus (GAS) (also known as Streptococcus pyogenes) infection. We report a young, otherwise healthy female who presented with generalized abdominal pain that was initially managed conservatively as gastroenteritis, with a computed tomography (CT) scan showing a ruptured corpus luteal cyst. Upon subsequent readmission with worsened pain and symptoms, a repeat CT scan showed worsened free fluid with signs of peritonitis. A diagnostic laparoscopy confirmed primary peritonitis with an unknown infection source and causative pathology, as the appendix, ovaries and bowels were healthy-looking. Fluid cultures returned positive for GAS Pyogenes, while blood and urine cultures were negative. The discussion reviews the challenges in diagnosis and treatment of GAS primary peritonitis, highlighting the need for clinical suspicion, early diagnosis via laparoscopy or laparotomy and prompt antibiotic therapy as the current standard for treatment.

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Section: Discussionsupporting

confidence: 51%

Primary Peritonitis Secondary to Streptococcus pyogenes in a Young Female Adult—A Case Report and Literature Review

Lee

Tay

2021

Infectious Disease Reports

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“…Several published studies reported that MDT intervention could benefit anti-infection management in the NICU ( Hamza et al, 2022 ). Neonatologists are encouraged to develop and implement antibiotic utilization strategies in collaboration with surgeons (surgical prophylaxis, the management of surgical infections) ( Robinson et al, 2020 ), infectious disease specialists (MIC and drug resistance), pharmacists (PK/PD theories, toxicities, interactions, and drug information), nurses (EI/CI care), and other NICU providers ( Katz et al, 2021 ). Moreover, it is imperative to note that autonomous learning about antimicrobial stewardship in neonatal sepsis through lectures, guidelines and consultations was not substantially correlated with a higher proportion of EI/CI use in our analysis.…”

Section: Discussionmentioning

confidence: 99%

The OBTAINS study: A nationwide cross-sectional survey on the implementation of extended or continuous infusion of β-lactams and vancomycin among neonatal sepsis patients in China

et al. 2022

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Background: Dosing strategies of β-lactams and vancomycin should be optimized according to pharmacokinetic/pharmacodynamic principles. However, there is no available data indicating the implementation of extended infusion (EI) or continuous infusion (CI) administration in the management of neonatal sepsis.Methods: A nationwide cross-sectional survey was conducted and the pediatricians from 31 provinces in China were enrolled. A multidisciplinary team created the questionnaire, which had three sections and a total of 21 questions with open- and closed-ended responses. The survey was then conducted using an internet platform in an anonymous way. The data was eventually gathered, compiled, and examined. To identify the risk factors associated with the implementation of EI/CI, logistic regression was carried out.Results: A total of 1501 respondents answered the questionnaires. The implementation of EI/CI of β-lactams and vancomycin were only available to one-third of the respondents, and the prolonged strategy was primarily supported by guidelines (71.25%) and advice from medical specialists (55.18%). A significant fraction (72.94%–94.71%) lacked a strong understanding of the infusions’ stability. Additionally, it was discovered that more frequent MDT discussions about antibiotic use and the appropriate time pediatricians worked in the neonatal ward were associated with an increase in the use of the EI/CI strategy.Conclusion: The EI/CI strategy in neonatal sepsis was not well recognized in China, and it is necessary to establish a solid MDT team with regularly collaborates. In the near future, guidelines regarding prolonged infusion management in neonatal sepsis should be developed.

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“…8,9 Additional drivers may be the paucity of surgeons in antimicrobial stewardship roles, and the perception that antimicrobials are a relatively risk-free intervention. 25,26 Regardless, this is an area of opportunity for ASPs.…”

Section: Discussionmentioning

confidence: 99%

Association between duration of antimicrobial prophylaxis and postoperative outcomes after lumbar spine surgery

Porter

Burdi

Casavant

et al. 2022

Infect. Control Hosp. Epidemiol.

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Objectives: To describe the association between duration of antimicrobial prophylaxis (AMP) and 30-day surgical site infection (SSI), 7-day acute kidney injury (AKI), 90-day Clostridioides difficile infection (CDI), prolonged hospitalization, and 30-day reoperation after lumbar spine surgery for noninfectious indications, and to report adherence to current guidelines. Design: Survey. Participants and setting: The study cohort comprised 6,198 patients who underwent lumbar spine surgery for noninfectious indications across 137 Veterans’ Health Administration surgery centers between 2016 and 2020. Methods: Used univariate and multivariate logistic regression to determine the association between type and duration of AMP with 30-day SSI, 7-day AKI, 90-day CDI, prolonged hospitalization, and 30-day reoperation. Results: Only 1,160 participants (18.7%) received the recommended duration of AMP. On multivariate analysis, the use of multiple prophylactic antimicrobials was associated with increased odds of 90-day CDI (adjusted odds ratio [aOR], 5.5; 95% confidence interval [CI], 1.1–28.2) and 30-day reoperation (aOR, 2.3; 95% CI, 1.2–4.4). Courses of antimicrobials ≥3 days were associated with increased odds of prolonged hospitalization (aOR,1.8; 95% CI, 1.4–2.3) and 30-day reoperation (aOR, 3.5; 95% CI, 2.2–5.7). In univariate analysis, increasing days of AMP was associated with a trend toward increasing odds of 90-day CDI (cOR, 1.4; 95% CI, 1.0–1.8 per additional day; P = .056). Conclusions: Longer courses of AMP after lumbar spine surgery were associated with higher odds of CDI, prolonged hospitalization, and reoperation, but not with lower odds of SSI. However, adherence to the recommended duration of AMP is very low, hinting at a wide evidence-to-practice gap that needs to be addressed by spine surgeons and antimicrobial stewardship programs.

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Collaborative Antimicrobial Stewardship for Surgeons

Cited by 7 publications

References 32 publications

Primary Peritonitis Secondary to Streptococcus pyogenes in a Young Female Adult—A Case Report and Literature Review

Primary Peritonitis Secondary to Streptococcus pyogenes in a Young Female Adult—A Case Report and Literature Review

The OBTAINS study: A nationwide cross-sectional survey on the implementation of extended or continuous infusion of β-lactams and vancomycin among neonatal sepsis patients in China

Association between duration of antimicrobial prophylaxis and postoperative outcomes after lumbar spine surgery

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