The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship—results from an international cross-sectional survey

Abstract

BackgroundAntimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world.MethodsA cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery.ResultsThe response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4–6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%).ConclusionThe survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-017-0145-2) contains supplementary material, which is available to authorized users.

Comparison of the Knowledge and Perception of Pharmacovigilance Among Pharmacy, Dental and Medical Students in Aden-Yemen

“…[20,21] To help students with positive attitudes towards reporting ADR in their future practice, there is a need to include training in ADR and PV in their curricula [23] to improve the clinical outcomes and promote the rational use of drugs. [24][25][26] More than half of the study population strongly agreed that ADR reporting should be made mandatory for professionals, indicating that students have positive perception towards PV and ADR reporting. The present study also found out that information not being provided by patients and weak promotional activities from the authorities was the major reasons that led to the failure in reporting ADR.…”

A proposal for a comprehensive approach to infections across the surgical pathway

“…Hospital-based programs dedicated to improving antibiotic use, commonly referred to as Antimicrobial stewardship programs (ASPs), can both optimize the treatment of infections and minimize adverse events associated with antibiotic use and AMR [44,45]. Every hospital worldwide should utilize the existing resources to create an effective multidisciplinary team.…”

“…Every hospital worldwide should utilize the existing resources to create an effective multidisciplinary team for combating AMR. The best strategies for combating AMR are not definitively established and are likely to vary based on local culture, policy, organization, and routine clinical practice despite several guidelines on the topic [44].…”

WARNING in Surgery

“…Furthermore, because medical professionals have already established their knowledge, attitudes, and behaviours about antibiotic use, it is difficult to change their deeply established views and practice patterns. 2 The necessity of improving awareness of the need for optimising antibiotics use, both for prophylaxis and therapy, has become increasingly urgent.…”

“…However if surgeons around the world participate in this global fight and demonstrate awareness of the major problem of antimicrobial resistance, they will be a pivotal element in this fight. 2 The Global Alliance for Infections in Surgery and the World Society of Emergency Surgery have promoted a coalition that should call for increased awareness and action across all surgical departments worldwide in order to combat AMR. This coalition will be able to join all the surgical scientific societies interested in combating AMR in the world.…”