Impact of antibiotic stewardship on perioperative antimicrobial prophylaxis

Murri, Rita; Belvis, Antonio Giulio de; Fantoni, Massimo; Tanzariello, Maria; Parente, Paolo; Marventano, Stefano; Bucci, Sabina; Giovannenze, Francesca; Ricciardi, Walter; Cauda, Roberto; Sganga, Gabriele

doi:10.1093/intqhc/mzw055

Cited by 24 publications

(21 citation statements)

References 20 publications

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“…59,60,61 Enabling interventions were found to “increase the means and reduce barriers to enhance capability and opportunity” 58 and were considered the most effective intervention type compared with restrictions of use by expert approval. 62 Examples of enabling interventions include audit and feedback, 59,60,61,63,64,65 educational outreach, 63,66 and clinical decision support systems. 67,68,69…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of Surgical Antimicrobial Prophylaxis Practices in Australia

et al. 2019

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Key PointsQuestionWhat are the current surgical antimicrobial prophylaxis prescribing practices in Australia, and what factors are associated with their appropriateness?FindingsThis quality improvement study of 9351 surgical episodes found high rates of inappropriate procedural and postprocedural antimicrobial use across various hospital, patient, and surgical factors. The most common reason for inappropriate procedural use was incorrect timing, while duration greater than 24 hours was the most common reason for inappropriate postprocedural use.MeaningThese findings suggest that the identified hospital, patient, and surgical factors should be considered as targets for development of tailored interventions to ensure appropriateness of surgical antimicrobial prophylaxis prescriptions.

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Section: Discussionmentioning

confidence: 99%

Appropriateness of Surgical Antimicrobial Prophylaxis Practices in Australia

et al. 2019

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“…Surgeons have a paramount role in antimicrobial stewardship and can contribute to prescribe antibiotics in a prudent manner. 17,18 We know ASP works but we also know that changing behavior remains a challenge. 19,20,21 Regarding all guidelines, meta-analyses, the international literature and the results of this retrospective observational study we can reason that a change of antimicrobial choice from Cefuroxime to Cefazolin as a perioperative antibiotic prophylaxis in cardiac surgery might not increase the rates of overall wound infections, including deep sternal wound infections as well as leg infections.…”

Section: Discussionmentioning

confidence: 99%

Implementation of Antimicrobial Stewardship Measures in Cardiac Surgery: Change of Protocol for Surgical Antibiotic Prophylaxis and Its Impact on Surgical Site Infections

Surat¹,

Bernsen²,

Schimmer³

2020

Preprint

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Objectives:The goal of this study was to evaluate the impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery comparing the new in hospital prophylactic agent cefazolin versus the former standard antibiotic cefuroxime, initiated by the antimicrobial stewardship team. Methods: This retrospective observational study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the antimicrobial stewardship team following a new recommendation of the surgical antimicrobial prophylaxis and included 1029 patients who underwent cardiac surgery. Two patient groups including 582 patients receiving Cefuroxime and 447 patients receiving Cefazolin respectively were compared without altering any other preventative perioperative measures. Adherence, overall infection rates, leg wound infections and deep sternal wound infections were compiled and analysed as well as a broad profile of preoperative, intraoperative and postoperative patient data. Results:A complete adherence on the change of the agent was achieved.Overall surgical site infections occurred in 37 (6.6%) of the cases, with 20 (3,4%) SSI in cefuroxime patients and 17 (3,8%) in cefazolin patients (p-value=0,754). No statistically significant differences could be found in any of the primary and secondary endpoints including DSWI (2,1% for cefuroxime, 1,3% for cefazolin), vein harvesting site infections (1,2% for cefuroxime, 2,2% for cefazolin) as well as urinary tract infections, pneumonia, sepsis and overall mortality of all causes. Conclusions:These results demonstrate that compliance to antimicrobial stewardship standards is not associated with more surgical site infections.

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“…This indicates that stewardship programs are necessary to achieve uniform routines. Active local feedback, repeated surveys and increasing awareness of antimicrobial resistance may improve compliance [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…The goals of STRAMA are to preserve the effectiveness of currently available antibiotics, to work for better basic hygiene precautions, and more appropriate choice, dosage, and length of antibiotic treatment. However, even if STRAMA has played an important role in the reduction of antibiotic use, there is still room for improvement [ 22 ]. The present study shows that antibiotic routines for preventing surgical site infections in one of the most common procedures in Sweden, gallstone surgery, vary radically at the individual as well as the hospital level.…”

Section: Discussionmentioning

confidence: 99%

Disparities in the regional, hospital and individual levels of antibiotic use in gallstone surgery in Sweden

Jaafar

Darkahi

Lindhagen³

et al. 2017

BMC Surg

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BackgroundAntimicrobial resistance may be promoted by divergent routines and lack of conformity in antibiotic treatment, especially regarding the practice of antibiotic prophylaxis. The aim of the present study was to assess differences in gallstone surgery regarding antibiotic use in Sweden.MethodsThe study was based on data from the Swedish Register for Gallstone Surgery and ERCP (GallRiks) 2005–2015. Funnel plots were used to test impact of grouping factors, including, hospital and surgeon and to identify units that deviated from the rest of the population.ResultsAfter adjusting for cofounders including age, gender, ASA classification, indication for surgery, operation time, gallbladder perforation and emergency status, there were 0/21 (0%) at the regional level, 18/76 (24%) at the hospital level and 128/1038 (12%) at the surgeon level outside the 99.9% confidence interval (CI). The estimated median odds ratios were 1.13 (95% CI 1.00–1.31) at the regional level, 1.93 (95% CI 1.70–2.19) at the hospital level and 2.38 (95% CI 2.26–2.50) at the surgeon level.ConclusionThere are significant differences between hospitals and surgeons, but little or no differences between regions. These deviations confirm the lack of standardization in regards to prescription of antibiotic prophylaxis and the need more uniform routines regarding antibiotic usage. Randomized controlled trials and large population-based studies are necessary to assess assessing the effectiveness and safety of antibiotic prophylaxis in gallstone surgery.

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Impact of antibiotic stewardship on perioperative antimicrobial prophylaxis

Abstract: Though results cannot be generalized to all hospital populations, the implemented intervention is likely to improve AP consequently improving quality of care and reducing costs. Further studies are needed to evaluate specific outcomes such as rate of SSIs and antibiotic resistance.

Cited by 24 publications

References 20 publications

Appropriateness of Surgical Antimicrobial Prophylaxis Practices in Australia

Appropriateness of Surgical Antimicrobial Prophylaxis Practices in Australia

Implementation of Antimicrobial Stewardship Measures in Cardiac Surgery: Change of Protocol for Surgical Antibiotic Prophylaxis and Its Impact on Surgical Site Infections

Disparities in the regional, hospital and individual levels of antibiotic use in gallstone surgery in Sweden

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