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Dellinger EP. What Is the Ideal Duration for Surgical Antibiotic Prophylaxis? Surg Infect (Larchmt) 2024; 25:1-6. [PMID: 38150526 DOI: 10.1089/sur.2023.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Background: Surgical antibiotic prophylaxis practice became common in the 1970s and has since become almost universal. The earliest articles used three doses over 12 hours with the first being administered before the start of the operation. Conclusions: The duration of prophylaxis has varied widely in practice over time, but an increasing body of evidence has supported shorter durations, most recently with recommendations in influential guidelines to avoid administration after the incision is closed.
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Affiliation(s)
- E Patchen Dellinger
- Department of Surgery, Division of General Surgery, University of Washington, Seattle, Washington, USA
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Guisado-Gil AB, Gutiérrez-Urbón JM, Ribed-Sánchez A, Luque-Pardos S, Sánchez-Cadena A, Mejuto B, Jaramillo-Ruiz D, Peñalva G, Cisneros JM. Analysis of the appropriateness of antibiotic prophylaxis in surgical procedures in Spain. Protocol for the "ProA-Q" study. FARMACIA HOSPITALARIA 2023; 47:224-229. [PMID: 37296032 DOI: 10.1016/j.farma.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/13/2023] [Accepted: 05/03/2023] [Indexed: 06/12/2023] Open
Abstract
Surgical antibiotic prophylaxis is one of the most useful measures to prevent surgical wound infection. OBJECTIVE The aim of this project is to evaluate the appropriateness of the use of antibiotic prophylaxis in surgical procedures performed in Spanish hospitals, both globally and according to the type of surgery performed. METHOD For this purpose, an observational, retrospective, cross-sectional and multicenter study has been designed to collect all the variables that allow the evaluation of the appropriateness of surgical antibiotic prophylaxis by comparing the prescribed treatment, the recommendations included in the local guidelines and the consensus document of the Spanish Society of Infectious Diseases and Clinical Microbiology and the Spanish Association of Surgeons. Indication, choice of antimicrobial, dose, route and duration of administration, timing, re-dosing and duration of the prophylaxis will be taken into account. The sample will consist of patients who underwent scheduled or emergency surgery, either as inpatients or outpatients, in hospitals in Spain. A sample size of 2,335 patients has been established to estimate, with 95% confidence and 80% power, a percentage of appropriateness that is expected to be around 70%. Differences between variables will be analyzed using Student's t-test, Mann-Whitney U test, Chi-square test, or Fisher's test, as appropriate. The degree of agreement between the antibiotic prophylaxis recommended by the guidelines of the different hospitals and that recommended in the literature will be analyzed by calculating the Cohen's kappa indicator. Binary logistic regression analysis using generalized linear mixed models will be performed to identify possible factors associated with differences in the appropriateness of antibiotic prophylaxis. DISCUSSION The results of this clinical study will allow us to focus on specific surgical areas with higher rates of inappropriateness, identify key points of action and guide future strategies for antimicrobial stewardship programs in the area of antibiotic prophylaxis.
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Affiliation(s)
- Ana Belén Guisado-Gil
- Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España; Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, España
| | | | | | | | - Abraham Sánchez-Cadena
- Servicio de Farmacia, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Beatriz Mejuto
- Servicio de Farmacia, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Didiana Jaramillo-Ruiz
- Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España; Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla, Sevilla, España.
| | - Germán Peñalva
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, España
| | - José Miguel Cisneros
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, España
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Guisado-Gil AB, Gutiérrez-Urbón JM, Ribed-Sánchez A, Luque-Pardos S, Sánchez-Cadena A, Mejuto B, Jaramillo-Ruiz D, Peñalva G, Cisneros JM. [Translated article] Analysis of the appropriateness of antibiotic prophylaxis in surgical procedures in Spain. Protocol for the "ProA-Q" study. FARMACIA HOSPITALARIA 2023; 47:T224-T229. [PMID: 37658007 DOI: 10.1016/j.farma.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/13/2023] [Accepted: 05/03/2023] [Indexed: 09/03/2023] Open
Abstract
Surgical antibiotic prophylaxis is one of the most useful measures to prevent surgical wound infection. OBJECTIVE The aim of this project is to evaluate the appropriateness of the use of antibiotic prophylaxis in surgical procedures performed in Spanish hospitals, both globally and according to the type of surgery performed. METHOD For this purpose, an observational, retrospective, cross-sectional, and multicentre study has been designed to collect all the variables that allow the evaluation of the appropriateness of surgical antibiotic prophylaxis by comparing the prescribed treatment, the recommendations included in the local guidelines, and the consensus document of the Spanish Society of Infectious Diseases and Clinical Microbiology and the Spanish Association of Surgeons. Indication, choice of antimicrobial, dose, route and duration of administration, timing, re-dosing, and duration of the prophylaxis will be taken into account. The sample will consist of patients who underwent scheduled or emergency surgery, either as inpatients or outpatients, in hospitals in Spain. A sample size of 2335 patients has been established to estimate, with 95% confidence and 80% power, a percentage of appropriateness that is expected to be around 70%. Differences between variables will be analysed using Student's t-test, Mann-Whitney U test, Chi-square test, or Fisher's test, as appropriate. The degree of agreement between the antibiotic prophylaxis recommended by the guidelines of the different hospitals and that recommended in the literature will be analysed by calculating the Cohen's kappa indicator. Binary logistic regression analysis using generalised linear mixed models will be performed to identify possible factors associated with differences in the appropriateness of antibiotic prophylaxis. DISCUSSION The results of this clinical study will allow us to focus on specific surgical areas with higher rates of inappropriateness, identify key points of action and guide future strategies for antimicrobial stewardship programs in the area of antibiotic prophylaxis.
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Affiliation(s)
- Ana Belén Guisado-Gil
- Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | | | | | | | | | - Beatriz Mejuto
- Servicio de Farmacia, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Didiana Jaramillo-Ruiz
- Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla, Sevilla, Spain.
| | - Germán Peñalva
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - José Miguel Cisneros
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
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Effects of implementing a clinical pathway on antibiotic prophylaxis for patients who underwent an elective surgery. Sci Rep 2022; 12:20176. [PMID: 36418406 PMCID: PMC9684115 DOI: 10.1038/s41598-022-24145-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
A reduction in the unnecessary use of antibiotic prophylaxis can prevent antibiotic resistance and adverse drug events. We aimed to evaluate the effects of implementing clinical pathways (CPs) on adherence to a systematic and appropriate duration of antibiotic prophylaxis. We identified 61 eligible CPs and a total of 44,062 patients who underwent elective surgeries associated with CPs. The Poisson mixed model with an interrupted time-series analysis frame was applied to the patient-level data. This enabled a comparison of the adherence rate before and after CP implementation. Furthermore, we examined the effect of application or completion of CP on the adherence rate after implementation. Adherence to the antibiotic prophylaxis guideline substantially increased (incident rate ratio [IRR] 8.05; 95 confidence interval [CI] 2.64-24.55), compared with that before implementation. Following the implementation into the electronic entry system, we observed an improved adherence not only in CP completion but also in attempted CP execution (IRR of the executed but not completed cases 1.54; 95% CI 1.17-2.04; IRR of the executed and competed cases, 1.94; 95% CI 1.4-2.69). The implementation of CP into the electronic prescribing system was associated with a significant increase in the appropriate use of antibiotic prophylaxis among patients who underwent elective surgeries. The results suggest that a computer-assisted CP system for electronic health records could improve antibiotic adherence without significant expense.
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Corneci D, Torsin LI, Filimon CR, Tănase NV, Moisă E, Negoiță SI. Individualized surgical antibiotic prophylaxis – why, when, and how? ROMANIAN JOURNAL OF MILITARY MEDICINE 2022. [DOI: 10.55453/rjmm.2022.125.4.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
"Surgical site infections (SSI) greatly concern clinicians, as they are associated with significant morbidity and mortality, prolonged hospitalization, and costs. Antibiotic prophylaxis plays a pivotal role among the procedures that are usually employed for the prevention of surgical-related infections. This narrative review aims to cover some of the particular situations when the clinician might consider individualizing antibiotic prophylaxis for a patient. With the rising incidence of multi-drug resistant bacteria carriage among not only hospitalized or institutionalized patients but also patients from the community, there might be a tendency to use extended-spectrum antibiotics for longer periods for surgical infection prevention. However, the inappropriate use of antibiotics increases the selection pressure, thus favoring the spreading of resistant bacteria. Moreover, specific patient characteristics or pathologies might need to be considered to customize the type, dose, or length of administration of an antibiotic as surgical prophylaxis. Using prosthetic material or prolonged surgeries with large fluid shifts are other situations when individualized antibiotic prophylaxis might be thought of. Keeping in mind that it is of utmost importance that everyone adheres to the current guidelines for surgical antibiotic prophylaxis, customization of local protocols according to well-thought-out strategies might prove beneficial in SSI prevention."
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Tipping the balance: A systematic review and meta-ethnography to unfold the complexity of surgical antimicrobial prescribing behavior in hospital settings. PLoS One 2022; 17:e0271454. [PMID: 35857810 PMCID: PMC9299309 DOI: 10.1371/journal.pone.0271454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/01/2022] [Indexed: 11/19/2022] Open
Abstract
Surgical specialties account for a high proportion of antimicrobial use in hospitals, and misuse has been widely reported resulting in unnecessary patient harm and antimicrobial resistance. We aimed to synthesize qualitative studies on surgical antimicrobial prescribing behavior, in hospital settings, to explain how and why contextual factors act and interact to influence practice. Stakeholder engagement was integrated throughout to ensure consideration of varying interpretive repertoires and that the findings were clinically meaningful. The meta-ethnography followed the seven phases outlined by Noblit and Hare. Eight databases were systematically searched without date restrictions. Supplementary searches were performed including forwards and backwards citation chasing and contacting first authors of included papers to highlight further work. Following screening, 14 papers were included in the meta-ethnography. Repeated reading of this work enabled identification of 48 concepts and subsequently eight overarching concepts: hierarchy; fear drives action; deprioritized; convention trumps evidence; complex judgments; discontinuity of care; team dynamics; and practice environment. The overarching concepts interacted to varying degrees but there was no consensus among stakeholders regarding an order of importance. Further abstraction of the overarching concepts led to the development of a conceptual model and a line-of-argument synthesis, which posits that social and structural mediators influence individual complex antimicrobial judgements and currently skew practice towards increased and unnecessary antimicrobial use. Crucially, our model provides insights into how we might ‘tip the balance’ towards more evidence-based antimicrobial use. Currently, healthcare workers deploy antimicrobials across the surgical pathway as a safety net to allay fears, reduce uncertainty and risk, and to mitigate against personal blame. Our synthesis indicates that prescribing is unlikely to change until the social and structural mediators driving practice are addressed. Furthermore, it suggests that research specifically exploring the context for effective and sustainable quality improvement stewardship initiatives in surgery is now urgent.
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Polish Medical Doctors’ Opinions on Available Resources and Information Campaigns concerning Antibiotics and Antibiotic Resistance, a Cross-Sectional Study. Antibiotics (Basel) 2022; 11:antibiotics11070882. [PMID: 35884136 PMCID: PMC9311609 DOI: 10.3390/antibiotics11070882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Antibiotic resistance (ABR) is at the top of global health threats. This paper aims to assess Polish physicians’ readiness to impact ABR through prescribing routines. Methods: Surveying Polish physicians participating in specialization courses at the Center for Postgraduate Medical Education in Warsaw, Poland from October 2019 to March 2020. Results: Information was obtained from 504 physicians aged 25–59, mean 32.8 ± 5.9 years, mainly women (65%). Most doctors (78%) prescribed antibiotics at least once a week. Physicians indicated clinical practice guidelines as resources most often consulted in the management of infections (90%). However, clinical experience was also declared a powerful resource. In total, 54% of respondents recalled receiving information about the prudent use of antibiotics within 12 months, which partially translated into changing views (56%) and practice (42%). Physicians disagreed that national campaigns provide good promotion of prudent antibiotics use (75%) or that they are effective (61%). Only 40% of doctors were aware of the national campaign promoting responsible antibiotics use, 24% had heard about the European Antibiotic Awareness Day and 20% knew about the World Antimicrobial Awareness Week. Conclusions: Prescribers most often rely on clinical practice guidelines and their own experience as resources for antibiotics use. Doctors’ awareness of available resources and information campaigns concerning antibiotics and antibiotic resistance should be improved.
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Navirian H, Navyashree GA. Antimicrobial prophylaxis uses and incidence of surgical site infection in Jayanagar General Hospital, Bangalore, India. J Family Med Prim Care 2022; 11:1179-1183. [PMID: 35495821 PMCID: PMC9051696 DOI: 10.4103/jfmpc.jfmpc_1068_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/18/2021] [Accepted: 10/25/2021] [Indexed: 11/04/2022] Open
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Vazin A, Hatami-Mazinani N, Alemzadeh E, Dehghani F, Mahi-Birjand M. Compliance with Antibiotics Prophylaxis Guideline in Surgical Patients in ICUs of a Teaching Referral Hospital. Health Serv Insights 2022; 15:11786329221136437. [PMID: 36386270 PMCID: PMC9661573 DOI: 10.1177/11786329221136437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial prophylaxis used for surgical procedures remains one of the measures for the prevention of surgical site infections (SSIs). The present study was designed to assess the compliance with clinical practice guideline for antimicrobial prophylaxis in variable surgeries conducted in the intensive care units (ICUs) of a major referral hospital. This cross-sectional investigation was carried out by prospective data collected from October 2017 to March 2018 in the intensive care unit (ICU) of Nemazi hospital in Shiraz. Demographic characteristics, surgery type as well as antibiotic treatment were gathered from medical records and entered in data collection forms. We reviewed compliance and adherence of prophylactic antibiotic administration to the Infectious Diseases Society of America (IDSA) guideline and evaluated the courses of antimicrobial drugs. If an antibiotic administrated for surgical prophylaxis was different from the guideline, the antibiotic was classified as non-guideline-based antibiotics. Most patients participated in this study were male (64.5%). Only 8.75% of the administrated antibiotics chosen for surgical prophylaxis were found to be appropriate antibiotic prescriptions; however, those patients receiving appropriate antibiotics prescribed an inappropriate dosage. In addition, the antibiotics were administrated with inappropriate durations in all cases. Our findings indicated that adherence to the IDSA international guideline seems to be far from ideal in Namazi hospital for antimicrobial prophylaxis, resulting in the unsuitable administration of a wide variety of antibiotics.
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Affiliation(s)
- Afsaneh Vazin
- Department of Clinical Pharmacy, School of pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazafarin Hatami-Mazinani
- Department of Clinical Pharmacy, School of pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Effat Alemzadeh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Fatemeh Dehghani
- Student Research Committee, Larestan University of Medical Sciences, Laresta, Iran
| | - Motahareh Mahi-Birjand
- Department of Clinical Pharmacy, School of Pharmacy, Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Roupie C, Labat B, Morin-Grognet S, Thébault P, Ladam G. Nisin-based antibacterial and antiadhesive layer-by-layer coatings. Colloids Surf B Biointerfaces 2021; 208:112121. [PMID: 34600362 DOI: 10.1016/j.colsurfb.2021.112121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
Some removable medical devices such as catheters and cardiovascular biomaterials require antiadhesive properties towards both prokaryotic and eukaryotic cells in order to prevent the tissues from infections upon implantation and, from alteration upon removal. In order to inhibit cell adhesion, we developed ultrathin hydrated Layer-by-Layer (LbL) coatings composed of biocompatible polyelectrolytes, namely chondroitin sulfate A (CSA) and poly-l-lysine (PLL). The coatings were crosslinked with genipin (GnP), a natural and biocompatible crosslinking agent, to increase their resistance against environmental changes. In order to confer antibacterial activity to the coatings, we proceeded to the electrostatically-driven immobilization of nisin Z, an antimicrobial peptide (AMP) active against gram-positive bacteria. The nisin-enriched coatings had a significantly increased anti-proliferative impact on fibroblasts, as well as a strong contact-killing activity against Staphylococcus aureus in the short and long term.
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Affiliation(s)
- Charlotte Roupie
- Normandie Univ, UNIROUEN, INSA Rouen, CNRS, PBS, Bd Maurice de Broglie, 76821 Mont Saint Aignan Cedex, France; Normandie Univ, UNIROUEN, INSA Rouen, CNRS, PBS, 55 rue Saint-Germain, 27000 Évreux, France
| | - Béatrice Labat
- Normandie Univ, UNIROUEN, INSA Rouen, CNRS, PBS, 55 rue Saint-Germain, 27000 Évreux, France
| | - Sandrine Morin-Grognet
- Normandie Univ, UNIROUEN, INSA Rouen, CNRS, PBS, 55 rue Saint-Germain, 27000 Évreux, France
| | - Pascal Thébault
- Normandie Univ, UNIROUEN, INSA Rouen, CNRS, PBS, Bd Maurice de Broglie, 76821 Mont Saint Aignan Cedex, France
| | - Guy Ladam
- Normandie Univ, UNIROUEN, INSA Rouen, CNRS, PBS, 55 rue Saint-Germain, 27000 Évreux, France.
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Maruyama R, Fukushima H, Fukuda S, Yasuda Y, Uehara S, Tanaka H, Kijima T, Yoshida S, Yokoyama M, Matsuoka Y, Saito K, Kihara K, Fujii Y. Nonuse of antimicrobial prophylaxis in clean surgeries for adrenal and renal tumors: Results of the risk-based strategy in 1362 consecutive patients. Int J Urol 2021; 28:1032-1038. [PMID: 34247430 DOI: 10.1111/iju.14642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the incidence of perioperative infections without antimicrobial prophylaxis in patients undergoing clean surgeries for adrenal and renal tumors. METHODS We prospectively enrolled 1362 consecutive patients who underwent minimally invasive adrenalectomy (n = 303), radical nephrectomy (n = 499), and partial nephrectomy (n = 560) using the gasless laparoendoscopic single-port surgery technique between 2005 and 2019. In 1059 patients, antimicrobial prophylaxis was not administered. The remaining 303 patients were considered at high risk for infection and received single-dose antimicrobial prophylaxis. The endpoint was the incidence of perioperative infections within 1 month from the surgery date. Perioperative infections were classified into surgical site infections, urinary tract infections, and remote infections. RESULTS Seventy-four patients whose collecting systems were opened during partial nephrectomy were excluded, and the remaining 1013 patients with nonuse of antimicrobial prophylaxis and 275 patients with single-dose antimicrobial prophylaxis were retrospectively analyzed. The incidence of superficial surgical site infections, deep/organ-space surgical site infections, urinary tract infections, and remote infections was 1.6%, 0.7%, 2.8%, and 1.3%, respectively, in patients with nonuse of antimicrobial prophylaxis and 0.4%, 1.8%, 1.5%, and 1.5%, respectively, in patients with single-dose antimicrobial prophylaxis. All patients who developed perioperative infections were successfully treated. No clinical or surgical variables were significantly associated with the incidence of surgical site infections. One limitation of the present study was its nonrandomized and noncontrolled design. CONCLUSIONS In minimally invasive clean surgeries for adrenal and renal tumors, antimicrobial prophylaxis is not necessary when individual risk of infection is considered low.
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Affiliation(s)
- Riko Maruyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Fukushima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yosuke Yasuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshiki Kijima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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van Mun LAM, Bosman SJE, de Vocht J, de Kort J, Schouten J. Barriers and Facilitators in Perioperative Antibiotic Prophylaxis: A Mixed-Methods Study in a Small Island Setting. Antibiotics (Basel) 2021; 10:462. [PMID: 33921814 PMCID: PMC8073237 DOI: 10.3390/antibiotics10040462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022] Open
Abstract
Few studies have addressed antibiotic guideline adherence in small island settings, such as Aruba. This study aimed to evaluate the appropriateness of perioperative antibiotic prophylaxis (PAP) and identify barriers for PAP guideline adherence. A mixed-methods study was carried out at the operating theatre (OT) in the Dr. Horacio E. Oduber Hospital (HOH) in Aruba. First, a prospective audit was performed on the appropriateness of guideline-derived quality indicators (QIs). Then, interviews based on the Flottorp framework were conducted to identify barriers for guideline adherence. Finally, a survey was distributed to verify the outcomes of the interviews. The appropriateness of QIs was measured: correct indication (50.6%); antimicrobial agent (30.8%); dose (94.4%); timing (55.0%); route of administration (100%); duration (89.5%); and redosing (95.7%). The overall appropriateness was 34.9%. The main barriers discovered were poor knowledge about PAP and the guidelines and professional interactions regarding PAP, specifically poor communication and lack of clarity about responsibilities regarding PAP. This study was the first to evaluate the appropriateness and to identify barriers for PAP guideline adherence in a small island hospital. The overall appropriateness of PAP was poor with just 34.9%. Future interventions should be focused on communication, education and awareness of the possibility to consult an ID physician or microbiologist.
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Affiliation(s)
- Liza A. M. van Mun
- Radboud Center for Infectious Diseases (RCI), RadboudUMC, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Gelderland, The Netherlands; (J.d.V.); (J.S.)
| | - Sabien J. E. Bosman
- Radboud Center for Infectious Diseases (RCI), RadboudUMC, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Gelderland, The Netherlands; (J.d.V.); (J.S.)
| | - Jessica de Vocht
- Radboud Center for Infectious Diseases (RCI), RadboudUMC, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Gelderland, The Netherlands; (J.d.V.); (J.S.)
| | - Jaclyn de Kort
- Department of Internal Medicine, Dr. Horacio E. Oduber Hospital, Dr. Horacio E. Oduber Boulevard #1, Oranjestad, Aruba;
| | - Jeroen Schouten
- Radboud Center for Infectious Diseases (RCI), RadboudUMC, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Gelderland, The Netherlands; (J.d.V.); (J.S.)
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13
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Martzivanou EC, Psarras K, Monioudis P, Vamvakis K, Nikolaidou C, Geropoulos G, Pavlidis ET, Symeonidis N, Pavlidis TE. Perioperative Antibiotic Prophylaxis: An Educative Intervention Significantly Increases Compliance. J Clin Med Res 2021; 13:170-176. [PMID: 33854657 PMCID: PMC8016525 DOI: 10.14740/jocmr4447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/01/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Implementation of guidelines in daily clinical practice is often suboptimal, mainly due to doctors' poor compliance with them. Perioperative antibiotic prophylaxis (PAP) is many times administered in patients undergoing elective surgery without proper indication or for longer time than needed. Aim of this study is to investigate the effect of a simple intervention on the compliance of the medical staff with the American Society of Health-System Pharmacists (ASHP) guidelines concerning PAP administration. METHODS A prospective 3-month audit took place including routine surgical procedures (laparoscopic cholecystectomy, inguinal hernia repair and thyroidectomy). An intervention aiming to educate the medical staff was implemented. The intervention included the demonstration of a poster and the training of the medical staff over the guidelines. A re-audit recorded the changes in daily clinical practice. RESULTS The compliance rate regarding the number of PAP doses significantly increased from 0% before the intervention to 68.8% after the intervention for hernia repair and to 53.1% for laparoscopic cholecystectomy. The adherence rate in thyroidectomies increased from 25% to 50%, but without statistical significance. No significant difference was found for other parameters of PAP administration, namely the type of antibiotic used and the timing of the dose administration. Regarding secondary outcomes, hospitalization days were reduced, and cost of antibiotics was significantly decreased (P < 0.05). CONCLUSIONS A simple intervention intending to educate the medical staff was successful in achieving significant improvement on the compliance rate with the PAP guidelines, highlighting the importance of promoting adherence to the already existing, well-established guidelines.
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Affiliation(s)
- Eirini Chrysovalantou Martzivanou
- Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Corresponding Author: Eirini Chrysovalantou Martzivanou, Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Kyriakos Psarras
- Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Monioudis
- Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Christina Nikolaidou
- Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Geropoulos
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Efstathios T. Pavlidis
- Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Symeonidis
- Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros E. Pavlidis
- Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Salm L, Marti WR, Stekhoven DJ, Kindler C, Von Strauss M, Mujagic E, Weber WP. Impact of bodyweight-adjusted antimicrobial prophylaxis on surgical-site infection rates. BJS Open 2020; 5:6044705. [PMID: 33688947 PMCID: PMC7944861 DOI: 10.1093/bjsopen/zraa027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/30/2020] [Accepted: 09/19/2020] [Indexed: 12/12/2022] Open
Abstract
Background Antimicrobial prophylaxis (AMP) adjustment according to bodyweight to prevent surgical-site infections (SSI) is controversial. The impact of weight-adjusted AMP dosing on SSI rates was investigated here. Methods Results from a first study of patients undergoing visceral, vascular or trauma operations, and receiving standard AMP, enabled retrospective evaluation of the impact of bodyweight and BMI on SSI rates, and identification of patients eligible for weight-adjusted AMP. In a subsequent observational prospective study, patients weighing at least 80 kg were assigned to receive double-dose AMP. Risk factors for SSI, including ASA classification, duration and type of surgery, wound class, diabetes, weight in kilograms, BMI, age, and AMP dose, were evaluated in multivariable analysis. Results In the first study (3508 patients), bodyweight and BMI significantly correlated with higher rates of all SSI subclasses (both P < 0.001). An 80-kg cut-off identified patients receiving single-dose AMP who were at higher risk of SSI. In the prospective study (2161 patients), 546 patients weighing 80 kg or more who received only single-dose AMP had higher rates of all SSI types than a group of 1615 who received double-dose AMP (odds ratio (OR) 4.40, 95 per cent c.i. 3.18 to 6.23; P < 0.001). In multivariable analysis including 5021 patients from both cohorts, bodyweight (OR 1.01, 1.00 to 1.02; P = 0.008), BMI (OR 1.01, 1.00 to 1.02; P = 0.007) and double-dose AMP (OR 0.33, 0.23 to 0.46; P < 0.001) among other variables were independently associated with SSI rates. Conclusion Double-dose AMP decreases SSI rates in patients weighing 80 kg or more.
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Affiliation(s)
- L Salm
- Department of General Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | | | - D J Stekhoven
- NEXUS Personalized Health Technologies, ETH Zurich, Zurich, Switzerland
| | - C Kindler
- Department of Anaesthesia, Kantonsspital Aarau, Aarau, Switzerland
| | - M Von Strauss
- Department of General Surgery, University Hospital Basle, Basle, Switzerland
| | - E Mujagic
- Department of General Surgery, University Hospital Basle, Basle, Switzerland
| | - W P Weber
- Department of General Surgery, University Hospital Basle, Basle, Switzerland
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Moges G, Belete L, Mengesha Y, Ahmed S. Evaluation of Surgical Antimicrobial Prophylaxis and Incidence of Surgical Site Infection at Borumeda Hospital, Northeast Ethiopia: Retrospective Cross-Sectional Study. DRUG HEALTHCARE AND PATIENT SAFETY 2020; 12:257-268. [PMID: 33304108 PMCID: PMC7723029 DOI: 10.2147/dhps.s280442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/22/2020] [Indexed: 12/21/2022]
Abstract
Background Surgical site infections are global healthcare problems. Although surgical site infections are preventable, they still cause significant morbidity, high death rates, and financial stress on national budgets and individual patients. Inappropriate uses of surgical antimicrobial prophylaxis are increasing and worsening patients’ quality of life. This study determined the incidence and risk factors of surgical site infections. Methods Institution-based retrospective cross-sectional study was conducted using a structured data abstraction format on patients who were attending at the surgical ward of Borumeda hospital from April 1, 2017, to March 31, 2019. The data were collected during July 15–30, 2019. A systematic random sampling technique was employed to select 227 surgical cases. Multivariate logistic regression was computed using the statistical package for social sciences version 23. Results The incidence of surgical site infections was 46.7%. Prophylaxis was administered to 188 (82.8%) surgical cases. Prophylaxis was recommended for 151 (66.5%). Out of these, only 143 (94.7%) received prophylaxis. One hundred seventy-four (78.4%) of the procedures had appropriate indication. The compliance of surgical antimicrobial prophylaxis use was 13.7%. The predictors of surgical site infections were receiving prophylaxis more than 24 h after surgery (AOR=3.53, 95% CI: 1.22–10.17), clean-contaminated wounds (AOR=4.54, 95% CI: 1.33–15.53), surgical procedure of thyroidectomy (AOR=5.2, 95% CI: 0.9–21.4), appendectomy (AOR = 29, 95% CI: 6.2–141.7), cholecystectomy (AOR = 21, 95% CI: 3.5 −126.7), hernia (AOR= 8.8, 95% CI: 1.2–62.2), skin and deep tissue (AOR = 125, 95% CI: 7.8–196.7), and orthopedic (AOR=57, 95% CI: 1.6–209.5). Conclusion There was high inconsistency between surgical antimicrobial prophylaxis practice and international surgical site infections prevention guideline. Wrong selection of antimicrobial agents was the most noncompliant to the guidelines. The incidence of surgical antimicrobial prophylaxis was high and requires due attention. The duration of postoperative prophylaxis should be kept to less than 24 h.
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Affiliation(s)
- Getachew Moges
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Lielet Belete
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yohannes Mengesha
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Solomon Ahmed
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Perioperative antimicrobial prophylaxis in adult patients: The first multicenter clinical practice audit with intervention in Greek surgical departments. Infect Control Hosp Epidemiol 2020; 42:702-709. [PMID: 33198846 DOI: 10.1017/ice.2020.1276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To audit clinical practice and implement an intervention to promote appropriate use of perioperative antimicrobial prophylaxis (PAP). DESIGN Prospective multicenter before-and-after study. SETTING This study was conducted in 7 surgical departments of 3 major Greek hospitals. METHODS Active PAP surveillance in adults undergoing elective surgical procedures was performed before and after implementation of a multimodal intervention. The surveillance monitored use of appropriate antimicrobial agent according to international and local guidelines, appropriate timing and duration of PAP, overall compliance with all 3 parameters and the occurrence of surgical site infections (SSIs). The intervention included education, audit, and feedback. RESULTS Overall, 1,447 patients were included: 768 before and 679 after intervention. Overall compliance increased from 28.2% to 43.9% (P = .001). Use of antimicrobial agents compliant to international guidelines increased from 89.6% to 96.3% (P = .001). In 4 of 7 departments, compliance with appropriate timing was already >90%; an increase from 44.3% to 73% (P = .001) and from 20.4% to 60% (P = .001), respectively, was achieved in 2 other departments, whereas a decrease from 64.1% to 10.9% (P = .001) was observed in 1 department. All but one department achieved a shorter PAP duration, and most achieved duration of ~2 days. SSIs significantly decreased from 6.9% to 4% (P = .026). After the intervention, it was 2.3 times more likely for appropriate antimicrobial use, 14.7 times more likely to administer an antimicrobial for the appropriate duration and 5.3 times more likely to administer an overall appropriate PAP. CONCLUSION An intervention based on education, audit, and feedback can significantly contribute to improvement of appropriate PAP administration; further improvement in duration is needed.
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Parker H, Frost J, Britten N, Robinson S, Mattick K. Understanding surgical antimicrobial prescribing behaviour in the hospital setting: a systematic review and meta-ethnography protocol. Syst Rev 2020; 9:236. [PMID: 33038928 PMCID: PMC7548039 DOI: 10.1186/s13643-020-01477-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surgical specialities use extensive amounts of antimicrobials, and misuse has been widely reported, making them a key target for antimicrobial stewardship initiatives. Interventions informed by, and tailored to, a clear understanding of the contextual barriers to appropriate antimicrobial use are more likely to successfully improve practice. However, this approach has been under utilised. Our aim is to synthesise qualitative studies on surgical antimicrobial prescribing behaviour (APB) in hospital settings to explain how and why contextual factors act and interact to influence APB amongst surgical teams. We will develop new theory to advance understanding and identify knowledge gaps to inform further research. METHODS The meta-ethnography will follow the seven-phase method described by Noblit and Hare. We will conduct a comprehensive search using eight databases (AMED, CINAHL, EMBASE, MEDLINE, MEDLINE-in-process, Web of Science, Cochrane Library and PsycINFO) with no date restrictions; forwards and backwards citation searches; and contacting first authors of relevant papers. Studies will be dual screened and included if they use recognised qualitative methods and analysis; focus on contextual factors associated with surgical APB within hospital settings; are available in full in English; and are relevant to the research question. Any disagreements between reviewers will be resolved through discussion to reach consensus. Included studies will be read repeatedly to illuminate key concepts and the relationship between key concepts across studies. Then, key concepts will be sorted into conceptual categories or 'piles' which will be further abstracted to form a conceptual framework explaining surgical APB. During the synthesis, emerging interpretations will be discussed with stakeholders (including authors of included studies where possible; surgical and stewardship practitioners; and patient representatives) to ensure new knowledge is meaningful. DISCUSSION This research has several strengths: (1) the protocol has been written with reference to established guidance maximising rigour and transparency; (2) the multi-disciplinary research team bring varied interpretative repertoires and relevant methodological skills; and (3) stakeholders will be involved to ensure that findings are relevant, and disseminated via suitable channels, to support improved patient care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020184343.
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Affiliation(s)
- Hazel Parker
- Pharmacy Department, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.
| | - Julia Frost
- South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Nicky Britten
- South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sophie Robinson
- South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Karen Mattick
- South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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Rodríguez VM, Clara L, Klajn D, Colque Á, Herrera MP, Angeleri P. [Multicenter study of adherence to guidelines on surgical prophylaxis and the determinants of non-adherence in ArgentinaEstudo multicêntrico sobre a adesão a diretrizes de profilaxia cirúrgica e seus determinantes na Argentina]. Rev Panam Salud Publica 2020; 44:e52. [PMID: 32973903 PMCID: PMC7498290 DOI: 10.26633/rpsp.2020.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/31/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Evaluate the level of adherence to guidelines on surgical prophylaxis in health facilities in Argentina and the determinants of non-adherence. METHODS Cross-sectional multicenter study in 35 centers in Argentina. The level of adherence to guidelines and the forms of non-adherence were determined and these were compared based on the characteristics of the indicated antibiotic, anesthesiologist, surgery, and facility, as well as patient age. An adjusted logistic regression model was used. RESULTS A total of 1,083 surgical procedures were reviewed. Adherence to guidelines was 67%. The most frequent forms of non-adherence were: incorrect antibiotic (28.9%), unnecessary prophylaxis (25.5%), and prolonged prophylaxis (24.4%). Adherence to guidelines was higher in persons under 18 years of age (84.9% compared to 65.5%, p < 0.001). According to the type of health coverage (social welfare, private insurance, public coverage, or community coverage), adherence was 33.3%, 64.4%, 78.8%, and 83.3%, respectively; p < 0.001. According to population (maternal and child, pediatric, specific pathologies, and general pathologies), adherence was 97.9%, 97.2%, 89.4%, and 63.2%, respectively; p < 0.001. Adherence was highest in neurosurgery (91.1%), obstetrics (82.4%), and cardiovascular surgery (72.9%), and lowest in otorhinolaryngology (47.8%), ophthalmology (50%), and urology (55.9%) (p < 0.001). The adjusted analysis showed the highest adherence to guidelines in persons under 18 (odds ratio [OR]: 4.97; 95% confidence interval [CI 95]: 1.13-21.80); emergency surgery (OR: 2.18; CI 95: 1.11-4.26); and public, private, and community facilities (OR: 9.35; CI 95: 3.85-22.70). Adherence was also higher in facilities for maternal and child care and specific pathologies (OR: 10.52; CI 95, 1.30-85.12), cardiovascular surgery, neurosurgery, obstetrics (OR: 2.73; CI 95: 1.55-4.78), and facilities with programs to optimize the use of antimicrobial drugs (OR 1.95; CI 95, 1.10-3.45). CONCLUSIONS Adherence to guidelines was 67%. Incorrect, unnecessary, and prolonged use of antibiotics were the most frequent forms of non-adherence. Adherence was higher with younger patients, where programs exist to optimize the use of antimicrobial drugs, where there is private or public health coverage, with the pediatric population, for specific pathologies, in emergency surgery, and in certain specialties.
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Affiliation(s)
- Viviana M Rodríguez
- Hospital General de Agudos E. TornúCiudad Autónoma de Buenos AiresArgentinaHospital General de Agudos E. Tornú, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Liliana Clara
- Hospital Italiano de Buenos AiresCiudad Autónoma de Buenos AiresArgentinaHospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Diana Klajn
- Hospital General de Agudos E. TornúCiudad Autónoma de Buenos AiresArgentinaHospital General de Agudos E. Tornú, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Ángel Colque
- Complejo Médico de la Policía Federal Argentina Churruca ViscaCiudad Autónomas de Buenos AiresArgentinaComplejo Médico de la Policía Federal Argentina Churruca Visca, Ciudad Autónomas de Buenos Aires, Argentina.
| | - María Paula Herrera
- Instituto Médico de Alta ComplejidadSaltaArgentinaInstituto Médico de Alta Complejidad, Salta, Argentina.
| | - Patricia Angeleri
- Comisión de Infecciones Asociadas a los Cuidados de la Salud y Seguridad del Paciente, Sociedad Argentina de InfectologíaArgentinaComisión de Infecciones Asociadas a los Cuidados de la Salud y Seguridad del Paciente, Sociedad Argentina de Infectología, Argentina.
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Ierano C, Thursky K, Peel T, Koning S, James R, Johnson S, Hall L, Worth LJ, Marshall C. Factors associated with antimicrobial choice for surgical prophylaxis in Australia. JAC Antimicrob Resist 2020; 2:dlaa036. [PMID: 34223002 PMCID: PMC8210066 DOI: 10.1093/jacamr/dlaa036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/29/2020] [Accepted: 04/05/2020] [Indexed: 11/13/2022] Open
Abstract
Background Cefazolin is the most commonly recommended antimicrobial for surgical antimicrobial prophylaxis (SAP). However, the Australian Surgical National Antimicrobial Prescribing Survey revealed a wide range of antimicrobials prescribed for SAP. Inappropriate use of broad-spectrum antimicrobials is associated with increased patient harm and is a posited driver for antimicrobial resistance. Objectives To describe patient, hospital and surgical factors that are associated with appropriateness of the top five prescribed antimicrobials/antimicrobial classes for procedural SAP. Methods All procedures audited from 18 April 2016 to 15 April 2019 in the Surgical National Antimicrobial Prescribing Survey were included in the analysis. Estimated marginal means analyses accounted for a range of variables and calculated a rate of adjusted appropriateness (AA). Subanalyses of the top five audited antimicrobials/antimicrobial classes identified associations between variables and appropriateness. Results A total of 12 419 surgical episodes with 14 150 prescribed initial procedural doses were included for analysis. When procedural SAP was prescribed, appropriateness was low (57.7%). Allergy status, surgical procedure group and the presence of prosthetic material were positively associated with cefazolin and aminoglycoside appropriateness (P < 0.05). There were no significant positive associations with glycopeptides and third/fourth-generation cephalosporins. The use of broad-spectrum antimicrobials was the most common reason for inappropriate choice (67.9% of metronidazole to 83.3% of third/fourth-generation cephalosporin prescriptions). Conclusions Various factors influence appropriateness of procedural SAP choice. Identification of these factors provides targets for antimicrobial stewardship interventions, e.g. procedures where surgeons are regularly prescribing broad-spectrum SAP. These can be tailored to address local hospital prescribing practices.
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Affiliation(s)
- Courtney Ierano
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Melbourne, VIC 3000, Australia.,University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC 3010, Australia
| | - Karin Thursky
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Melbourne, VIC 3000, Australia.,University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC 3010, Australia
| | - Trisha Peel
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Melbourne, VIC 3000, Australia.,Department of Infectious Diseases, Alfred Health/Monash University, Melbourne, VIC 3004, Australia
| | - Sonia Koning
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Melbourne, VIC 3000, Australia
| | - Rod James
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Melbourne, VIC 3000, Australia
| | - Sandra Johnson
- Victorian Healthcare Associated Infection Surveillance System (VICNISS), Melbourne, VIC 3000, Australia
| | - Lisa Hall
- School of Public Health, University of Queensland, Brisbane, QLD 4006, Australia
| | - Leon J Worth
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Melbourne, VIC 3000, Australia.,University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC 3010, Australia.,Victorian Healthcare Associated Infection Surveillance System (VICNISS), Melbourne, VIC 3000, Australia
| | - Caroline Marshall
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Melbourne, VIC 3000, Australia.,University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC 3010, Australia.,Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Parkville, VIC 3050, Australia.,Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
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AbuRuz S, Jaber D, Basheti I, Sadeq A, Arafat M, AlAhmad M, Said A. Impact of pharmacist interventions on drug-related problems in general surgery patients: a randomised controlled trial. Eur J Hosp Pharm 2020; 28:e72-e78. [PMID: 32661104 DOI: 10.1136/ejhpharm-2020-002206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/07/2020] [Accepted: 06/08/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The inappropriate use of medications is harmful and is a common issue in hospitalised patients. Patients hospitalised in general surgery wards are usually at high risk for drug-related problems (DRPs). This randomised controlled trial aimed to explore the value of a pharmaceutical care service conducted in general surgery wards in the identification and reduction of DRPs in comparison with standard medical care. METHODS This study was conducted in general surgery wards including abdominal, cardiovascular, vascular, endocrine, orthopaedic and oncological surgeries at one of the largest teaching hospitals in Jordan over a period of 6 months. Recruited patients were randomised into intervention or control groups. Clinical pharmacists assessed patients' DRPs and submitted recommendations to resolve the identified DRPs in the intervention group. RESULTS Patients in the intervention group (n=63) and the control group (n=60) had a mean age of 55±14.4 years, with 52.0% being women. A total of 1062 DRPs were identified, with a mean of 8.6±3.6 per patient (intervention group, 8.65±4.2; control group, 8.62±2.6; p=0.56). The commonly identified DRPs included safety (20.2%) and efficacy (19.0%) issues. The acceptance rate for pharmacists' recommendations by physicians was very high (90%) with a good DRP correction rate of 58.9% during patients' hospital stay. The value of pharmaceutical care was significantly reflected in the achievement of the therapeutic outcomes and prevention of morbidity (resolved/improved or prevented) of 68.2% (24.2%+44%) in the intervention group compared with 19.2% (12.4%+6.8%) in the control group (p<0.001). CONCLUSIONS This study shows that DRPs are common among general surgery patients in Jordan, especially those related to drug safety and efficacy. Pharmacists' recommendations contributed substantially to resolving most of the identified DRPs and had a significant impact on improving medications used in general surgery patients.
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Affiliation(s)
- Salah AbuRuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates .,Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Deema Jaber
- Department of Clinical Pharmacy, School of Pharmacy, Zarqa University, Zarqa, Amman, Jordan
| | - Iman Basheti
- Department of Clinical Pharmacy and Therapeutics, Applied Science University, Amman, Jordan
| | - Aya Sadeq
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Mosab Arafat
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Mohammad AlAhmad
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Amira Said
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates
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Ahmed AM, Nasr S, Ahmed AM, Elkhidir O. Knowledge, attitude and practice of surgical staff towards preoperative surgical antibiotic prophylaxis at an academic tertiary hospital in Sudan. Patient Saf Surg 2019; 13:42. [PMID: 31827619 PMCID: PMC6905001 DOI: 10.1186/s13037-019-0224-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 12/05/2019] [Indexed: 11/10/2022] Open
Abstract
Background Surgical site infections (SSIs) are among the most common serious complications after surgery and associated with preventable morbidity, mortality, and increased health care costs. The use of surgical antimicrobial prophylaxis (SAP) is an effective measure that helps to protect against SSIs. This study aims to evaluate the knowledge, attitude, and practice of surgical staff towards preoperative antibiotic prophylaxis in surgery department at an academic tertiary hospital in Sudan. Methodology An observational descriptive study was conducted among doctors in the surgery department at an academic tertiary hospital in Sudan in order to assess their knowledge, attitude, and practice (KAP) towards surgical antibiotic prophylaxis (SAP). A four-section multiple-choice questionnaire was designed and hand-delivered to registered doctors in the surgery department at an academic tertiary hospital in Sudan. The WHO guidelines were used to evaluate the answers of the participants. Results Out of 56 doctors requested to participate in this study, only 49 responded and their response rate was 87.5%. Six (12.5%) surgeons had good knowledge about appropriate SAP. However, 16.3 and 24.5% of the respondents were aware of appropriate SAP in the case of Ig E-mediated reaction to penicillin and risk of Gram-negative infections, respectively. The surgeon's attitude score about the need for local and national guidelines for SAP was 98 and 100%, respectively. Accordance of the physician's practice with ASHP guidelines regarding timing of the first dosage of SAP was 35.4% while correct administration of an intraoperative dose was 42.9% in agreement with the guideline. 53.1% knows when to stop SAP after surgery correctly. Conclusion Although the participants in this study showed a positive attitude towards antibiotic prophylaxis guidelines, their knowledge and strict adherence to a protocolized practice per WHO checklist should be improved in order to reduce the incidence of preventable surgical site infections.
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Affiliation(s)
- Ali Mohammed Ahmed
- 1Faculty of Medicine, SAMER research group, Khartoum University, Alqaser street, 11111 Khartoum, Sudan
| | - Sara Nasr
- 1Faculty of Medicine, SAMER research group, Khartoum University, Alqaser street, 11111 Khartoum, Sudan
| | - Almegdad Mohamed Ahmed
- 1Faculty of Medicine, SAMER research group, Khartoum University, Alqaser street, 11111 Khartoum, Sudan
| | - Osama Elkhidir
- 2Department of community medicine, Faculty of Medicine, Khartoum University, Alqaser street, 11111 Khartoum, Sudan
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Ierano C, Thursky K, Marshall C, Koning S, James R, Johnson S, Imam N, Worth LJ, Peel T. Appropriateness of Surgical Antimicrobial Prophylaxis Practices in Australia. JAMA Netw Open 2019; 2:e1915003. [PMID: 31702804 PMCID: PMC6902799 DOI: 10.1001/jamanetworkopen.2019.15003] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Surgical antimicrobial prophylaxis (SAP) is a common indication for antibiotic use in hospitals and is associated with high rates of inappropriateness. OBJECTIVE To describe the SAP prescribing practices and assess hospital, surgical, and patient factors associated with appropriate SAP prescribing. DESIGN, SETTING, AND PARTICIPANTS Multicenter, national, quality improvement study with retrospective analysis of data collected from Australian hospitals via Surgical National Antimicrobial Prescribing Survey audits from January 1, 2016, to June 30, 2018. Data were analyzed using multivariable logistic regression. Crude estimates of appropriateness were adjusted for factors included in the model by calculating estimated marginal means and presented as adjusted-appropriateness with 95% confidence intervals. MAIN OUTCOMES AND MEASURES Adjusted appropriateness and factors associated with inappropriate prescriptions. RESULTS A total of 9351 surgical episodes and 15 395 prescriptions (10 740 procedural and 4655 postprocedural) were analyzed. Crude appropriateness of total prescriptions was 48.7% (7492 prescriptions). The adjusted appropriateness of each surgical procedure group was low for procedural SAP, ranging from 33.7% (95% CI, 26.3%-41.2%) for dentoalveolar surgery to 68.9% (95% CI, 63.2%-74.5%) for neurosurgery. The adjusted appropriateness of postprocedural prescriptions was also low, ranging from 21.5% (95% CI, 13.4%-29.7%) for breast surgery to 58.7% (95% CI, 47.9%-69.4%) for ophthalmological procedures. The most common reason for inappropriate procedural SAP was incorrect timing (44.9%), while duration greater than 24 hours was the most common reason for inappropriate postprocedural SAP (54.3%). CONCLUSIONS AND RELEVANCE High rates of inappropriate procedural and postprocedural antimicrobial use were demonstrated across all surgical specialties. Reasons for inappropriateness, such as timing and duration, varied according to the type of SAP and surgical specialty. These findings highlight the need for improvement in SAP prescribing and suggest potential targeted areas for action.
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Affiliation(s)
- Courtney Ierano
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne, Australia
- University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Karin Thursky
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne, Australia
- University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Caroline Marshall
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne, Australia
- University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Australia
- Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, Australia
| | - Sonia Koning
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne, Australia
| | - Rod James
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne, Australia
| | - Sandra Johnson
- Victorian Healthcare Associated Infection Surveillance System, Melbourne, Australia
| | - Nabeel Imam
- Victorian Healthcare Associated Infection Surveillance System, Melbourne, Australia
| | - Leon J. Worth
- University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Victorian Healthcare Associated Infection Surveillance System, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Trisha Peel
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health/Monash University, Melbourne, Australia
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Bertschi D, Weber WP, Zeindler J, Stekhoven D, Mechera R, Salm L, Kralijevic M, Soysal SD, von Strauss M, Mujagic E, Marti WR. Antimicrobial Prophylaxis Redosing Reduces Surgical Site Infection Risk in Prolonged Duration Surgery Irrespective of Its Timing. World J Surg 2019; 43:2420-2425. [PMID: 31292675 DOI: 10.1007/s00268-019-05075-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Long-duration surgery requires repeated administration of antimicrobial prophylaxis (amp). Amp "redosing" reduces incidence of surgical site infections (SSI) but is frequently omitted. Clinical relevance of redosing timing needs to be investigated. Here, we evaluated the effects of compliance with amp redosing and its timing on SSI incidence in prolonged duration surgery. METHODS Data from >9000 patients undergoing visceral, trauma, or vascular surgery with elective or emergency treatment in two tertiary referral Swiss hospitals were analyzed. All patients had to receive amp preoperatively and redosing, if indicated. Antibiotics used were cefuroxime (1.5 or 3 g, if weight >80 kg), or cefuroxime and metronidazole (1.5 and 0.5 g, or 3 and 1 g doses, if weight >80 kg). Alternatively, in cases of known or suspected allergies, vancomycin (1 g), gentamicin (4 mg/Kg), and metronidazole or clindamycin (300 mg) with or without ciprofloxacin (400 mg) were used. Association of defined parameters, including wound class, ASA scores, and duration of operation, with SSI incidence was explored. RESULTS In the whole cohort, SSI incidence significantly correlated with duration of surgery (ρ = 0.73, p = 0.031). In 593 patients undergoing >240 min long interventions, duration of surgery was the only parameter significantly (p < 0.001) associated with increased SSI risk, whereas wound class, ASA scores, treatment areas, and emergency versus elective hospital entry were not. Redosing significantly reduced SSI incidence as shown by multivariate analysis (OR 0.60, 95% CI 0.37-0.96, p = 0.034), but exact timing had no significant impact. CONCLUSIONS Long-duration surgery associates with higher SSI incidence. Irrespective of its exact timing, amp redosing significantly decreases SSI risk.
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Affiliation(s)
- Daniela Bertschi
- Department of Visceral Surgery, Kantonsspital Chur, Chur, Switzerland
| | - Walter P Weber
- Department of General Surgery, University Hospital Basel, Basel, Switzerland
| | - Jasmin Zeindler
- Department of General Surgery, University Hospital Basel, Basel, Switzerland
| | - Daniel Stekhoven
- NEXUS Personalized Health Technologies, ETH Zurich, Zurich, Switzerland
| | - Robert Mechera
- Department of General Surgery, University Hospital Basel, Basel, Switzerland
| | - Lilian Salm
- Department of Visceral Surgery, Kantonsspital Aarau, Chirurgieaarau, Bahnhofstrasse 24, 5000, Aarau, Switzerland
| | - Marco Kralijevic
- Department of General Surgery, University Hospital Basel, Basel, Switzerland
| | - Savas D Soysal
- Department of General Surgery, University Hospital Basel, Basel, Switzerland
| | - Marco von Strauss
- Department of Visceral Surgery, Kantonsspital Aarau, Chirurgieaarau, Bahnhofstrasse 24, 5000, Aarau, Switzerland
| | - Edin Mujagic
- Department of General Surgery, University Hospital Basel, Basel, Switzerland
| | - Walter R Marti
- Department of Visceral Surgery, Kantonsspital Aarau, Chirurgieaarau, Bahnhofstrasse 24, 5000, Aarau, Switzerland.
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Machowska A, Sparrentoft J, Dhakaita SK, StålsbyLundborg C, Sharma M. Perioperative antibiotic prescribing in surgery departments of two private sector hospitals in Madhya Pradesh, India. Perioper Med (Lond) 2019; 8:10. [PMID: 31523421 PMCID: PMC6734588 DOI: 10.1186/s13741-019-0121-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/31/2019] [Indexed: 12/02/2022] Open
Abstract
Background Single-dose perioperative antibiotic prophylaxis (PAP) is recommended for clean, non-infectious surgeries to prevent surgical site infections. However, the common practice of unindicated use and prolonged use of antibiotics contributes to the development and spread of antibiotic resistance (ABR). The present study explores the perioperative use of antibiotics among inpatients with surgical indications at surgery departments of a teaching (TH) and a non-teaching (NTH) tertiary care hospital in Madhya Pradesh, India. Methods Data was collected manually for all inpatients for 3 years (April 2008–August 2011). Patients with non-infectious surgical indications were selected for detailed analysis at the diagnosis group level. Results Out of 12,434 enrolled inpatients (TH 6171 and NTH 6263), the majority (> 85%) received antibiotics. None of the inpatients received the recommended single-dose PAP. The average duration of antibiotic treatment was significantly longer at the TH compared to the NTH (9.5 vs 4.4 days, p < 0.001). Based on the study aim, 5984 patients were classified in four diagnosis groups: upper or lower urinary tract surgery indications (UUTSI and LUTSI), and routine or emergency abdominal surgery indications (RASI and EASI). In both hospitals, quinolones were the most prescribed antibiotics for UUTSI (TH 70%, NTH 37%) and LUTSI (TH 70%, NTH 61%) antibiotic. In the TH, aminoglycosides (TH 32%) were commonly prescribed for RASI and imidazole derivatives (75%) for EASI. In the NTH, cephalosporins (39%) and imidazole derivatives (56%) were the most prescribed in RASI and EASI, respectively. Conclusions and recommendations High prescribing of antibiotics in all four selected diagnoses groups was observed at both hospitals. In spite of the recommended single-dose PAP, antibiotics were mainly prescribed for longer durations. The unrecommended use of antibiotics is a risk factor for the development of AMR. Improving the quality of antibiotic prescribing by a stewardship program focusing on the development and implementation of local prescribing guidelines is needed.
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Affiliation(s)
- Anna Machowska
- 1Department of Public Health Sciences, Global Health - Health Systems and Policy, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Jonatan Sparrentoft
- 1Department of Public Health Sciences, Global Health - Health Systems and Policy, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Shyam Kumar Dhakaita
- 3Department of Surgery, Ruxmaniben Deepchand Gardi Medical College, Surasa, Ujjain, 456006 India
| | - Cecilia StålsbyLundborg
- 1Department of Public Health Sciences, Global Health - Health Systems and Policy, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Megha Sharma
- 1Department of Public Health Sciences, Global Health - Health Systems and Policy, Karolinska Institutet, 17177 Stockholm, Sweden.,2Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, Surasa, Ujjain, 456006 India
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Ierano C, Ayton D, Peel T, Marshall C, Thursky K. Evaluating the implementability of Antibiotic Surgical Prophylaxis guidelines. Infect Dis Health 2019; 25:11-21. [PMID: 31523036 DOI: 10.1016/j.idh.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Current Australian data highlight guideline noncompliant prescribing of antimicrobials for surgical prophylaxis. The study aim was to evaluate the implementability of the Australian national surgical prophylaxis (SAP) guidelines to identify facilitators for and barriers to compliance. METHODS Key stakeholders appraised the surgical prophylaxis guidelines using the GuideLine Implementability Appraisal (GLIA) tool. Questions with 100% agreement for the response 'Yes' were identified as facilitators and those with 100% agreement for 'No', a barrier. Questions that did not receive 100% agreement, but had a majority (40-60%) 'Yes' or 'No' consensus were considered as borderline facilitators and barriers respectively. RESULTS Ten appraisals were completed. Guideline recommendations were rated as easily identifiable and concise and were thus facilitators for implementation. The ability to measure guideline adherence and outcomes, and recommendations that were consistent with guideline user abilities and beliefs were also identified as facilitators. Borderline facilitators related to the clarity of the recommendations and whether they were explicit in what to do and in what circumstances. Evidence quality underpinning recommendations (validity), inflexibility of recommendations (flexibility) and the lack of patient data at the point of use (computability) were identified as borderline barriers to implementation. No recommendation reached agreement as being a barrier. CONCLUSION The GLIA appraisal demonstrated overall implementability of the current Australian national surgical prophylaxis guidelines. Facilitators (i.e., measurability) and borderline facilitators highlight strengths of the current guideline. Borderline barriers (i.e., validity, flexibility and computability) may negatively impact upon implementability. Guideline developers should consider these dimensions to optimise guideline uptake and consequently patient care.
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Affiliation(s)
- Courtney Ierano
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, VIC, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - Darshini Ayton
- Monash University, Department of Epidemiology and Preventive Medicine, 553 St Kilda Road, Melbourne, VIC, Australia
| | - Trisha Peel
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Health/Monash University, Melbourne, VIC, Australia
| | - Caroline Marshall
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, VIC, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia; Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, VIC, Australia; Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Karin Thursky
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, VIC, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Komagamine J, Yabuki T, Kobayashi M, Okabe T. Prevalence of antimicrobial use and active healthcare-associated infections in acute care hospitals: a multicentre prevalence survey in Japan. BMJ Open 2019; 9:e027604. [PMID: 31256027 PMCID: PMC6609065 DOI: 10.1136/bmjopen-2018-027604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To determine the prevalence of antimicrobial drug use and active healthcare-associated infections (HAIs) and to evaluate the appropriateness of antimicrobial therapy in acute care hospitals in Japan. DESIGN A prospective multicentre cross-sectional study. PARTICIPANTS All hospitalised patients on a survey day. MAIN OUTCOME MEASURES The primary outcome was the proportion of patients receiving any antimicrobial agents. The secondary outcome was the proportion of patients with active HAIs. The reasons for antimicrobial drug use and appropriateness of antibiotic therapy were also investigated. RESULTS Eight hundred twenty eligible patients were identified. The median patient age was 70 years (IQR 55-80); 380 (46.3%) were women, 150 (18.3%) had diabetes mellitus and 107 (13.1%) were immunosuppressive medication users. The proportion of patients receiving any antimicrobial drugs was 33.5% (95% CI 30.3% to 36.8%). The proportion of patients with active HAIs was 7.4% (95% CI 5.6% to 9.2%). A total of 327 antimicrobial drugs were used at the time of the survey. Of those, 163 (49.8%), 101 (30.9%) and 46 (14.1%) were used for infection treatment, surgical prophylaxis and medical prophylaxis, respectively. The most commonly used antimicrobial drugs for treatment were ceftriaxone (n=25, 15.3%), followed by piperacillin-tazobactam (n=22, 13.5%) and cefmetazole (n=13, 8.0%). In the 163 antimicrobial drugs used for infection treatment, 62 (38.0%) were judged to be inappropriately used. CONCLUSIONS The prevalence of antimicrobial use and active HAIs and the appropriateness of antimicrobial therapy in Japan were similar to those of other developed countries. A strategy to improve the appropriateness of antimicrobial therapy provided to hospitalised patients is needed. TRIAL REGISTRATION NUMBER UMIN000033568.
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Affiliation(s)
- Junpei Komagamine
- Internal Medicine, National Hospital Orginization Tochigi Medical Center, Utsunomiya, Japan
| | - Taku Yabuki
- Internal Medicine, National Hospital Orginization Tochigi Medical Center, Utsunomiya, Japan
| | - Masaki Kobayashi
- Geriatrics and Gerontology, National Hospital Organisation Tokyo Medical Center, Meguro-ku, Japan
| | - Taro Okabe
- Internal Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
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Alghamdi S, Shebl NA, Aslanpour Z, Shibl A, Berrou I. Hospital adoption of antimicrobial stewardship programmes in Gulf Cooperation Council countries: A review of existing evidence. J Glob Antimicrob Resist 2018; 15:196-209. [DOI: 10.1016/j.jgar.2018.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/12/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022] Open
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Fujibayashi A, Niwa T, Tsuchiya M, Takeichi S, Suzuki K, Ohta H, Yonetamari J, Niwa A, Yamamoto M, Hatakeyama D, Baba H, Suzuki A, Murakami N. Antimicrobial stewardship intervention for the clinical pathways improves antimicrobial prophylaxis in surgical or non-surgical invasive therapies. Int J Clin Pract 2018; 73:e13293. [PMID: 30414352 DOI: 10.1111/ijcp.13293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/02/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The standard duration of administration of antimicrobial prophylaxis in surgery and non-surgical invasive therapy was shortened according to the promotion of appropriate use. Here, we conducted an intervention to optimise antimicrobial prophylaxis by revising all relevant clinical pathways based on the most recent guidelines. METHODS We conducted a single-centre, prospective cohort study in patients who received antimicrobial prophylaxis to evaluate outcomes following revision of the clinical pathways for antimicrobial prophylaxis. Antibiotic consumption and the duration of antibiotic administration were compared before and after revising the clinical pathways. RESULTS Thirty-five of 171 clinical pathways were considered inappropriate for antimicrobial use and were optimised. After this revision, the duration of antibiotic administration was significantly shortened (before revision: 3 [1-5] days vs after revision: 2 [1-3] days, median [interquartile range], P < 0.001). The rate of discontinuation of antibiotics within 48 h after surgery or non-surgical invasive therapy was significantly higher after the revision (62.4% vs 81.8%, P < 0.001). In contrast, the incidence of surgical site infection (SSI) was not significantly different before and after the revision (5.7% vs 4.3%, P = 0.177). A multivariate Cox proportional analysis indicated that revision of the clinical pathways was one of the prognostic factors associated with the discontinuation of antibiotics within 48 h after surgery or non-surgical invasive therapy (hazard ratio, 0.69; 95% confidence interval, 0.63-0.76, P < 0.001). CONCLUSIONS Our findings suggest that revising all relevant clinical pathways was highly effective in reducing antibiotic consumption and shortening the antibiotic administration period without increasing the incidence of SSIs.
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Affiliation(s)
- Ayasa Fujibayashi
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Takashi Niwa
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Mayumi Tsuchiya
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Syuri Takeichi
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Keiko Suzuki
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Hirotoshi Ohta
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Jun Yonetamari
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Ayumi Niwa
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Masayo Yamamoto
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Daijiro Hatakeyama
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Hisashi Baba
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Nobuo Murakami
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
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Surgical antibiotic prophylaxis – The evidence and understanding its impact on consensus guidelines. Infect Dis Health 2018. [DOI: 10.1016/j.idh.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Longitudinal point prevalence survey of antibacterial use in Northern Ireland using the European Surveillance of Antimicrobial Consumption (ESAC) PPS and Global-PPS tool. Epidemiol Infect 2018; 146:985-990. [PMID: 29690946 DOI: 10.1017/s095026881800095x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Antimicrobial resistance is a limiting factor for the success of the treatment of infectious diseases and is associated with increased morbidity and cost. The present study aims to evaluate prescribing patterns of antimicrobials and quantify progress in relation to targets for quality improvement in the prescription of antimicrobials in Northern Ireland's secondary care sector using three repetitive point prevalence surveys (PPS) over a 6-year period: the European Surveillance of Antimicrobial Consumption (ESAC-PPS) in 2009 and 2011 and the Global-PPS on Antimicrobial Consumption and Resistance in 2015. Out of 3605 patients surveyed over the three time points, 1239 (34.4%) were treated with an antibiotic, the most frequently prescribed antibiotic groups were a combination of penicillins, including β-lactamase inhibitors. Compliance with hospital antibiotic policies in 2009, 2011 and 2015 were 54.5%, 71.5% and 79.9%, respectively. Likewise, an indication for treatment was recorded in patient notes 88.5%, 87.7% and 90.6% in 2009, 2011 and 2015, respectively, and surgical prophylactic antibiotic prescriptions for >24 h was 3.9%, 3.2% and 0.7% in 2009, 2011 and 2015, respectively. Treatment based on biomarker data was used in 61.5% of cases. In conclusion, a general trend in the improvement of key antimicrobial-related quality indicators was noted. The PPS tool provided a convenient, inexpensive surveillance system of antimicrobial consumption and should be considered an essential component to establish and maintain informed antibiotic stewardship in hospitals.
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Antibiotic Prophylaxis With Cefuroxime: Influence of Duration on Infection Rate With Staphylococcus aureus in a Contaminated Open Fracture Model. J Orthop Trauma 2018; 32:190-195. [PMID: 29558373 DOI: 10.1097/bot.0000000000001053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The optimal duration of perioperative antibiotic prophylaxis (PAP) for open fractures remains controversial because of heterogeneous or unclear guidelines and highly variable prophylactic regimens in clinical practice. We aimed at testing different PAP durations under controlled conditions in a contaminated rabbit fracture model. METHODS A complete humeral osteotomy in 18 rabbits was fixed with a 7-hole locking compression plate and inoculated with Staphylococcus aureus. Cefuroxime was administered in a weight-adjusted dosage equivalent to human medicine (18.75 mg/kg). PAP was administered as a single shot only; for 24 hours; or for 72 hours in separate groups of rabbits (n = 6 per group). Infection was assessed after 2 weeks by quantitative bacteriological evaluation of the tissues and hardware. RESULTS Postoperative duration of PAP had a significant impact on the success of antibiotic prophylaxis in this model. Whereas the single-shot regimen completely failed to prevent infection, the 24-hour regimen showed a reduced infection rate (1 of 6 rabbits infected), but only the 72-hour course was able to prevent fracture-related infection in all animals in our model. CONCLUSIONS When contamination with high bacterial loads is likely (eg, in an open fracture situation), a 72-hour course of intravenous cefuroxime seems to be superior in preventing fracture-related infection in our rabbit model compared with a single-shot or 24-hour antibiotic regimen.
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Abdel Jalil MH, Abu Hammour K, Alsous M, Hadadden R, Awad W, Bakri F, Fram K. Noncompliance with surgical antimicrobial prophylaxis guidelines: A Jordanian experience in cesarean deliveries. Am J Infect Control 2018; 46:14-19. [PMID: 28800838 DOI: 10.1016/j.ajic.2017.06.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Surgical site infections are common, especially in developing countries. Nevertheless, up to 60% of surgical site infections can be prevented with appropriate perioperative care, which includes among other measures using suitable surgical antimicrobial prophylaxis (SAP). METHODS After a short interview with patients and retrospective review of medical charts, compliance with 6 SAP parameters was assessed for appropriateness; those parameters are indication, choice, dose, time of administration, intraoperative redosing interval, and duration of prophylaxis in 1,173 operations. RESULTS Overall compliance was poor; nevertheless, certain components showed high compliance rates, such as indication and choice of antibiotics. The most frequent error noted was extended administration of prophylactic antibiotics, which was observed in 88.2% of the study population. Emergency operations were associated with a lower risk of noncompliance in administering the correct dose at the correct time (odds ratio, 0.63; 95% confidence interval, 0.47-0.83 and odds ratio, 0.21; 95% confidence interval, 0.14-0.3, respectively). On the other hand, women who underwent an emergency operation were associated with a 6-fold higher risk of receiving prophylactic therapy following surgery. CONCLUSIONS The present study demonstrated the existence of a surprisingly low level of overall compliance with the hospital-adapted SAP guidelines. Factors implicated in noncompliance were investigated, and the present results create a starting point to improve the current practice.
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Affiliation(s)
- Mariam Hantash Abdel Jalil
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan.
| | - Khawla Abu Hammour
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | - Mervat Alsous
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Rand Hadadden
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | - Wedad Awad
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | - Faris Bakri
- Division of Infectious Diseases, Department of medicine, University of Jordan, Jordan University Hospital, Amman, Jordan; Infectious Diseases and Vaccine Center, University of Jordan, Amman, Jordan
| | - Kamil Fram
- Department of Obstetrics and Gynecology, University of Jordan, Jordan University Hospital, Amman, Jordan
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Li G, Pu K, Cao Y, Wang J, Sun Z, Li Q. The Role of Antibiotic Prophylaxis in Shunt Surgery. World Neurosurg 2017; 108:548-554. [DOI: 10.1016/j.wneu.2017.08.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/06/2017] [Accepted: 08/10/2017] [Indexed: 10/18/2022]
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Caruso TJ, Wang E, Schwenk HT, Scheinker D, Yeverino C, Tweedy M, Maheru M, Sharek PJ. A quality improvement initiative to optimize dosing of surgical antimicrobial prophylaxis. Paediatr Anaesth 2017; 27:702-710. [PMID: 28321988 DOI: 10.1111/pan.13137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The risk of surgical site infections is reduced with appropriate timing and dosing of preoperative antimicrobials. Based on evolving national guidelines, we increased the preoperative dose of cefazolin from 25 to 30 mg·kg-1 . This quality improvement project describes an improvement initiative to develop standard work processes to ensure appropriate dosing. AIMS The primary aim was to deliver cefazolin 30 mg·kg-1 to at least 90% of indicated patients. The secondary aim was to determine differences between accuracy of cefazolin doses when given as an electronic order compared to a verbal order. METHODS Data were collected from January 1, 2012 to May 31, 2016. A quality improvement team of perioperative physicians, nurses, and pharmacists implemented a series of interventions including new electronic medical record order sets, personal provider antibiotic dose badges, and utilization of pharmacists to prepare antibiotics to increase compliance with the recommended dose. Process compliance was measured using a statistical process control chart, and dose compliance was measured through electronic analysis of the electronic medical record. Secondary aim data were displayed as percentage of dose compliance. An unpaired t-test was used to determine differences between groups. RESULTS Between January 1, 2012 and May 31, 2016, cefazolin was administered to 9086 patients. The mean compliance of cefazolin at 30 mg·kg-1 from May 2013 to March 2014 was 40%, which prompted initiation of this project. From April 2014 to May 2016, a series of interventions were deployed. The mean compliance from September 2015 to May 2016 was 93% with significantly reduced variation and no special cause variation, indicating that the process was in control at the target primary aim. There were 649 cefazolin administrations given verbally and 1929 given with an electronic order between October 1, 2014 and May 31, 2016. During this time period, the rate of compliance of administering cefazolin at 30 mg·kg-1 was significantly higher when given after an electronic order than when given verbally, 94% vs 76%. CONCLUSION This comprehensive quality improvement project improved practitioner compliance with evidence-based preoperative antimicrobial dosing recommendations to reduce the risk of surgical site infections.
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Affiliation(s)
- Thomas J Caruso
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Ellen Wang
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Hayden T Schwenk
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA, USA
| | - David Scheinker
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Calida Yeverino
- Department of Pharmacy Services, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Mary Tweedy
- Department of Perioperative Services, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Manjit Maheru
- Department of Pharmacy Services, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Paul J Sharek
- Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA, USA
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Appropriateness of Surgical Antibiotic Prophylaxis in Pediatric Patients in Italy. Infect Control Hosp Epidemiol 2017; 38:823-831. [DOI: 10.1017/ice.2017.79] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVESAppropriate use of surgical antibiotic prophylaxis (SAP) reduces intraoperative wound contamination in pediatric surgery, thus minimizing the risk of surgical site infection (SSIs). Conversely, inappropriate use of SAP exposes patients to the risk of antibiotic side effects and contributes to the emergence of antimicrobial resistance. Our aims were to describe SAP administration and to analyze factors associated with nonadherence in pediatric patients.DESIGNDescriptive study.SETTINGOverall, 955 pediatric patients underwent 1,038 surgical procedures.METHODSWe assessed adherence to SAP international guidelines for surgical procedures performed on children aged <18 years in 2015 in 4 randomly selected hospitals in Calabria (Italy). The clinical records of these patients were retrospectively reviewed.RESULTSAppropriate SAP administration or nonadministration pertained to 754 surgical procedures (72.6%). Surgical antibiotic prophylaxis was administered in 88.5% of 358 procedures with an SAP indication. Adherence to guidelines for appropriate drug choice were followed in 5.7% of cases, for route of administration in 76.7% of cases, for timing in 48.6% of cases, for duration in 14.5% of cases, and for dose in 91.5% of cases, and for all components in only 5 cases (1.6%). Among 680 procedures without SAP indication, 35.7% case patients received antibiotics. Inappropriate administration of antibiotics in procedures without SAP indication was associated with surgical specialty wards (P=.008), ordinary admission (P<.001), head and neck surgical procedures (P=.020), clean surgery (P=.017), and surgical duration (P=.010).CONCLUSIONSDiscrepancies between SAP guidelines and actual practice behavior more frequently indicate excessive use of antibiotics than underuse. Increased awareness of SAP guidelines is required.Infect Control Hosp Epidemiol 2017;38:823–831
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Cao Y, Pu K, Li G, Yan X, Ma Y, Xue K, Sun Z, Li Q. The Role of Antibiotic Prophylaxis in Clean Neurosurgery. World Neurosurg 2017; 100:305-310. [PMID: 28104524 DOI: 10.1016/j.wneu.2016.12.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the efficacy of antibiotic prophylaxis (AP) and the risk factors for postoperative infections in clean neurosurgery. METHODS Data were retrospectively collected on all patients who had undergone clean neurosurgical operation at our institution between January 2009 and December 2014. From January 2009 until October 2011, AP was administered to every clean neurosurgical patient. From November 2011 to December 2014, no AP (n-AP) was prescribed for all clean neurosurgical operations. The efficacy of AP and independent risk factors for infection were studied. RESULTS A total of 808 clean neurosurgical cases were included. The AP group comprised 360 surgical cases, including 29 meningitis cases and 2 cases of incision infections, whereas the n-AP group consisted of 448 surgical cases, including 35 meningitis cases and 4 cases of incision infections (P = 0.848). Microorganisms were identified in 7 of 29 cases in the AP group compared with their identification in 22 of 35 cases in the n-AP group (P = 0.002). The percentage of patients with multidrug-resistant bacterial meningitis in the AP group was 57.1% compared with 13.6% in the n-AP group (P = 0.038). The risk factors for postoperative infection were cerebrospinal fluid leakage (odds ratio, 27.8; 95% confidence interval, 9.38-28.55) and surgery time (odds ratio, 1.12; 95% confidence interval, 1.02-1.22). CONCLUSIONS Our results show that in our data set, AP had no preventive effect on postoperative infections in clean neurosurgery. In addition, AP appeared to decrease the positive bacterial culture rate and to promote the emergence of multidrug-resistant bacteria. Cerebrospinal fluid leakage and surgery time were the risk factors for postoperative infection.
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Affiliation(s)
- YiYao Cao
- Graduate School of Tianjin Medical University, Tianjin, China; Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Ke Pu
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Disease, Tianjin Neurosurgical Institute, Tianjin, China
| | - Guodong Li
- Graduate School of Tianjin Medical University, Tianjin, China; Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - XueJiang Yan
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Yue Ma
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Kai Xue
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - ZhiMing Sun
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - QingGuo Li
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Disease, Tianjin Neurosurgical Institute, Tianjin, China.
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Mousavi S, Zamani E, Bahrami F. An Audit of Perioperative Antimicrobial Prophylaxis: Compliance with the International Guidelines. J Res Pharm Pract 2017; 6:126-129. [PMID: 28616437 PMCID: PMC5463548 DOI: 10.4103/jrpp.jrpp_16_164] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: Antimicrobial prophylaxis has been demonstrated to lower the incidence of postoperative infection in nearly all types of surgery. The American Society of Health-System Pharmacists (ASHP) guideline summarizes current data on the appropriate use of antibiotic for surgical prophylaxis. The objective of this study was to assess and audit the use of antibiotics in a tertiary care center according to the recommendation of ASHP guideline. Methods: This cross-sectional study was performed using prospective data gathered from April to September 2015 in the surgical wards of Al Zahra Hospital, Isfahan, Iran. Antibiotic indication and choice, dose, dosing interval, route of administration, and timing of first administration and duration of prophylaxis were compared with the ASHP guideline recommendations. Findings: A total of 100 patients with the mean age of 49.8 ± 18.2 years were recruited for this study. About 22% of procedures had full compliance with all guideline recommendations. The most frequently encounter noncompliance type were the duration of prophylaxis (14%) and appropriate agent choice (35%). Timing of the initial dose was appropriate in most of the procedures (42%). Conclusion: This study revealed that most of the prescribed antibiotics for surgical prophylaxis are not in accordance with standard treatment guideline. The density of antimicrobial use for preoperative antimicrobial prophylaxis is very high. Furthermore, the hospital should develop a formal strategy, including a local guideline for antimicrobial prophylaxis in surgical procedures.
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Affiliation(s)
- Sarah Mousavi
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Zamani
- Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Faranak Bahrami
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Ceballos M, Orozco LE, Valderrama CO, Londoño DI, Lugo LH. Cost-Effectiveness Analysis of the Use of a Prophylactic Antibiotic for Patients Undergoing Lower Limb Amputation due to Diabetes or Vascular Illness in Colombia. Ann Vasc Surg 2016; 40:327-334. [PMID: 27903479 DOI: 10.1016/j.avsg.2016.07.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/14/2016] [Accepted: 07/24/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of a prophylactic antibiotic in an amputation surgery is a key element for the successful recovery of the patient. We aim to determine, from the perspective of the Colombian health system, the cost-effectiveness of administering a prophylactic antibiotic among patients undergoing lower limb amputation due to diabetes or vascular illness in Colombia. METHODS A decision tree was constructed to compare the use and nonuse of a prophylactic antibiotic. The probabilities of transition were obtained from studies identified from a systematic review of the clinical literature. The chosen health outcome was reduction in mortality due to prevention of infection. The costs were measured by expert consensus using the standard case methodology, and the resource valuation was carried out using national-level pricing manuals. Deterministic sensitivity, scenarios, and probabilistic analyses were conducted. RESULTS In the base case, the use of a prophylactic antibiotic compared with nonuse was a dominant strategy. This result was consistent when considering different types of medications and when modifying most of the variables in the model. The use of a prophylactic antibiotic ceases to be dominant when the probability of infection is greater than 48%. CONCLUSIONS The administration of a prophylactic antibiotic was a dominant strategy, which is a conclusion that holds in most cases examined; therefore, it is unlikely that the uncertainty around the estimation of costs and benefits change the results. We recommend creating policies oriented toward promoting the use of a prophylactic antibiotic during amputation surgery in Colombia.
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Affiliation(s)
- Mateo Ceballos
- Health Technology Assessment Institute-IETS, Bogotá D.C., Colombia; Health Rehabilitation Group, School of Medicine, University of Antioquia, Medellín, Colombia.
| | - Luis Esteban Orozco
- Health Economy Group, School of Economic Sciences, University of Antioquia, Medellín, Colombia; School of Economics and Finance, EAFIT University, Medellín, Colombia
| | | | | | - Luz Helena Lugo
- Health Rehabilitation Group, School of Medicine, University of Antioquia, Medellín, Colombia; Physical Medicine and Rehabilitation Department, Las Américas Hospital, Medellín, Colombia
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Sartelli M, Duane TM, Catena F, Tessier JM, Coccolini F, Kao LS, De Simone B, Labricciosa FM, May AK, Ansaloni L, Mazuski JE. Antimicrobial Stewardship: A Call to Action for Surgeons. Surg Infect (Larchmt) 2016; 17:625-631. [PMID: 27828764 DOI: 10.1089/sur.2016.187] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Despite current antimicrobial stewardship programs (ASPs) being advocated by infectious disease specialists and discussed by national and international policy makers, ASPs coverage remains limited to only certain hospitals as well as specific service lines within hospitals. The ASPs incorporate a variety of strategies to optimize antimicrobial agent use in the hospital, yet the exact set of interventions essential to ASP success remains unknown. Promotion of ASPs across clinical practice is crucial to their success to ensure standardization of antimicrobial agent use within an institution. To effectively accomplish this standardization, providers who actively engage in antimicrobial agent prescribing should participate in the establishment and support of these programs. Hence, surgeons need to play a major role in these collaborations. Surgeons must be aware that judicious antibiotic utilization is an integral part of any stewardship program and necessary to maximize clinical cure and minimize emergence of antimicrobial resistance. The battle against antibiotic resistance should be fought by all healthcare professionals. If surgeons around the world participate in this global fight and demonstrate awareness of the major problem of antimicrobial resistance, they will be pivotal leaders. If surgeons fail to actively engage and use antibiotics judiciously, they will find themselves deprived of the autonomy to treat their patients.
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Affiliation(s)
| | - Therese M Duane
- 2 Department of Surgery, John Peter Smith Health Network , Fort Worth, Texas
| | - Fausto Catena
- 3 Department of Emergency Surgery, Maggiore Hospital , Parma, Italy
| | - Jeffrey M Tessier
- 4 Department of Infectious Diseases, John Peter Smith Health Network , Fort Worth, Texas
| | | | - Lillian S Kao
- 6 Department of Surgery, McGovern Medical School, University of Texas Health Science Center , Houston, Texas
| | | | - Francesco M Labricciosa
- 7 Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health , UNIVPM, Ancona, Italy
| | - Addison K May
- 8 Department of Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Luca Ansaloni
- 5 Department of Surgery, Papa XXIII Hospital , Bergamo, Italy
| | - John E Mazuski
- 9 Department of Surgery, Section of Acute and Critical Care Surgery, Washington University School of Medicine , St. Louis, Missouri
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Gouvêa M, Novaes CDEO, Iglesias AC. Assessment of antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital. Rev Col Bras Cir 2016; 43:225-34. [PMID: 27679941 DOI: 10.1590/0100-69912016004001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/04/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE : to evaluate the antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital - HUGG. METHODS : we conducted a rospective study of a cohort of 256 patients undergoing elective operations between January and September 2014. We collected data on demographics, use or not of prophylactic antibiotic and the antibiotic prophylaxis following characteristics: type of antibiotic used, moment of administration and duration of postoperative use. The analyzed outcomes were "justified use or non-use of antibiotic prophylaxis", "correct antibiotic choice," "administration of the antibiotic at the right time" and "discontinuation of the antibiotic at the right time." RESULTS : antibiotic prophylaxis was used in 91.8% of cases. The use or non-use of antibiotic prophylaxis was justified in 78.9% of patients, the choice of the administered antibiotic was considered correct in 97.9%, antibiotic administration was made at the right time in only 27.2% of patients and discontinuation of the antibiotic was performed at the correct time in 95.7% of cases. CONCLUSION : the surgical antibiotic prophylaxis was not fully adequately performed in the sample. OBJETIVO avaliar a antibioticoprofilaxia em pacientes cirúrgicos do Hospital Universitário Gaffrée e Guinle. MÉTODOS estudo prospectivo de uma coorte de 256 pacientes submetidos à operações eletivas, entre janeiro e setembro de 2014. Foram coletados dados demográficos dos pacientes, se ocorreu utilização ou não do antibiótico profilático e as seguintes características da antibioticoprofilaxia: tipo de antibiótico utilizado, momento da administração e tempo de duração do uso no pós-operatório. Os desfechos de interesse analisados foram "uso ou não uso justificado da antibioticoprofilaxia", "escolha correta do antibiótico", "administração do antibiótico no tempo correto" e "descontinuação do antibiótico no tempo correto". RESULTADOS a antibioticoprofilaxia foi utilizada em 91,8% dos casos. O uso ou não uso da antibioticoprofilaxia foi justificado em 78,9% dos pacientes, a escolha do antibiótico administrado foi considerada correta em 97,9%, a administração do antibiótico foi feita no momento correto em apenas 27,2% dos pacientes e a descontinuação do antibiótico foi realizada no tempo correto em 95,7% dos casos. CONCLUSÃO a antibioticoprofilaxia cirúrgica não foi realizada de forma plenamente adequada na amostra estudada.
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Affiliation(s)
- Marise Gouvêa
- - Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO)
| | | | - Antonio Carlos Iglesias
- - Department of General and Specialized Surgery, School of Medicine and Surgery, Federal University of the State of Rio de Janeiro (UNIRIO)
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Dou JL, Jiang YW, Xie JQ, Zhang XG. New Is Old, and Old Is New: Recent Advances in Antibiotic-Based, Antibiotic-Free and Ethnomedical Treatments against Methicillin-Resistant Staphylococcus aureus Wound Infections. Int J Mol Sci 2016; 17:E617. [PMID: 27120596 PMCID: PMC4881443 DOI: 10.3390/ijms17050617] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 12/26/2022] Open
Abstract
Staphylococcus aureus is the most common pathogen of wound infections. Thus far, methicillin-resistant S. aureus (MRSA) has become the major causative agent in wound infections, especially for nosocomial infections. MRSA infections are seldom eradicated by routine antimicrobial therapies. More concerning, some strains have become resistant to the newest antibiotics of last resort. Furthermore, horizontal transfer of a polymyxin resistance gene, mcr-1, has been identified in Enterobacteriaceae, by which resistance to the last group of antibiotics will likely spread rapidly. The worst-case scenario, "a return to the pre-antibiotic era", is likely in sight. A perpetual goal for antibiotic research is the discovery of an antibiotic that lacks resistance potential, such as the recent discovery of teixobactin. However, when considering the issue from an ecological and evolutionary standpoint, it is evident that it is insufficient to solve the antibiotic dilemma through the use of antibiotics themselves. In this review, we summarized recent advances in antibiotic-based, antibiotic-free and ethnomedical treatments against MRSA wound infections to identify new clues to solve the antibiotic dilemma. One potential solution is to use ethnomedical drugs topically. Some ethnomedical drugs have been demonstrated to be effective antimicrobials against MRSA. A decline in antibiotic resistance can therefore be expected, as has been demonstrated when antibiotic-free treatments were used to limit the use of antibiotics. It is also anticipated that these drugs will have low resistance potential, although there is only minimal evidence to support this claim to date. More clinical trials and animal tests should be conducted on this topic.
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Affiliation(s)
- Jian-Lin Dou
- Institute of Pathogenic Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.
| | - Yi-Wei Jiang
- Spinal Surgery Department, Affiliated Hospital of Gansu University of Chinese Medicines, Lanzhou 730020, China.
| | - Jun-Qiu Xie
- Institute of Pathogenic Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.
| | - Xiao-Gang Zhang
- Spinal Surgery Department, Affiliated Hospital of Gansu University of Chinese Medicines, Lanzhou 730020, China.
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Negi V, Pal S, Juyal D, Sharma MK, Sharma N. Bacteriological Profile of Surgical Site Infections and Their Antibiogram: A Study From Resource Constrained Rural Setting of Uttarakhand State, India. J Clin Diagn Res 2015; 9:DC17-20. [PMID: 26557520 DOI: 10.7860/jcdr/2015/15342.6698] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/06/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Surgical site infections (SSI) constitute a major public health problem worldwide and are the second most frequently reported nosocomial infections. They are responsible for increasing the treatment cost, length of hospital stay and significant morbidity and mortality. AIM To determine the incidence of SSIs and the prevalence of aerobic bacterial pathogens involved with their antibiogram. MATERIALS AND METHODS Samples were collected using sterile cotton swabs from 137 patients clinically diagnosed of having SSIs and were processed as per standard microbiological techniques. Antimicrobial susceptibility testing was done using modified Kirby-Bauer disc diffusion method. This cross sectional study was conducted for a period of six months (January 2013 to June 2013) in the Department of Microbiology at a rural tertiary care hospital of Uttarakhand state, India. RESULTS Out of 768 patients, 137 (17.8%) were found to have SSIs and samples were collected from them. Out of total 137 samples, 132 (96.4%) yielded bacterial growth and 139 bacterial isolates were obtained. Staphylococcus aureus (50.4%) was the commonest organism followed by Escherichia coli (23.02%), Pseudomonas aeruginosa (7.9%) and Citrobacter species (7.9%). Antimicrobial profile of gram positive isolates revealed maximum sensitivity to vancomycin, teicoplanin and linezolid, whereas among gram negative isolates meropenem, piperacillin-tazobactam, and amikacin were found to be most sensitive. CONCLUSION The rate of SSI observed in this study was comparable to other similar studies, however we observed a higher degree of antimicrobial resistance. Adherence to strict infection control measures, maintenance of proper hand hygiene and optimal preoperative, intraoperative and postoperative patient care will surely reduce the incidence of SSIs.
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Affiliation(s)
- Vikrant Negi
- Former Junior Demonstrator, Department of Microbiology and Immunology, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute , Srinagar Garhwal, Uttarakhand, India
| | - Shekhar Pal
- Associate Professor, Department of Microbiology and Immunology, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute , Srinagar Garhwal, Uttarakhand, India
| | - Deepak Juyal
- Senior Demonstrator, Department of Microbiology and Immunology, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute , Srinagar Garhwal, Uttarakhand, India
| | - Munesh Kumar Sharma
- Senior Demonstrator, Department of Microbiology and Immunology, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute , Srinagar Garhwal, Uttarakhand, India
| | - Neelam Sharma
- Professor and Head, Department of Microbiology and Immunology, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute , Srinagar Garhwal, Uttarakhand, India
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Adherence to guidelines for surgical antibiotic prophylaxis: a review. Braz J Infect Dis 2015; 19:517-24. [PMID: 26254691 PMCID: PMC9427538 DOI: 10.1016/j.bjid.2015.06.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 11/28/2022] Open
Abstract
Context and objectives The appropriate use of antibiotic prophylaxis in the perioperative period may reduce the rate of infection in the surgical site. The purpose of this review was to evaluate adherence to guidelines for surgical antibiotic prophylaxis. Methods The present systematic review was performed according to the Cochrane Collaboration methodology. The databases selected for this review were: Medline (via PubMed), Scopus and Portal (BVS) with selection of articles published in the 2004–2014 period from the Lilacs and Cochrane databases. Results The search recovered 859 articles at the databases, with a total of 18 studies selected for synthesis. The outcomes of interest analyzed in the articles were as follows: appropriate indication of antibiotic prophylaxis (ranging from 70.3% to 95%), inappropriate indication (ranging from 2.3% to 100%), administration of antibiotic at the correct time (ranging from 12.73% to 100%), correct antibiotic choice (ranging from 22% to 95%), adequate discontinuation of antibiotic (ranging from 5.8% to 91.4%), and adequate antibiotic prophylaxis (ranging from 0.3% to 84.5%). Conclusions Significant variations were observed in all the outcomes assessed, and all the studies indicated a need for greater adherence to guidelines for surgical antibiotic prophylaxis.
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Testa M, Stillo M, Giacomelli S, Scoffone S, Argentero PA, Farina EC, Zotti CM. Appropriate use of antimicrobial prophylaxis: an observational study in 21 surgical wards. BMC Surg 2015; 15:63. [PMID: 25968324 PMCID: PMC4434534 DOI: 10.1186/s12893-015-0048-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 05/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surveillance of Surgical Site Infections (SSI) in 2010 found 39 % compliance with hospital guidelines in Piedmont (Italy). The aim of the study was to estimate the appropriate use of antimicrobial prophylaxis and compliance with hospitals guidelines in surgical wards. METHODS This survey study took place in 21 surgery wards of 4 public hospitals. Forms were completed by public health resident doctors together with a medical ward referent and infection control nurses. 15 consecutive surgical procedures were randomly chosen from each ward. A total of 320 cases were analyzed. The study period was from July 2012 to January 2013. Data were collected using a survey form. A final score variable from 0 to 4 was given to each case. The results were compared with hospital and international guidelines. Data were analyzed using Epi-Info software. RESULTS Of the 320 cases collected, 63 were excluded; of the remaining 257 cases, 56.4 % of the procedures were appropriate (score 4), 15.2 % were acceptable and 28.4 % were not acceptable. The study found an unjustified continuation of antimicrobial prophylaxis in 17.1 % of the 257 cases, an unjustified re-start of antimicrobial therapy in 9.7 % and a re-dosing omission in 7.8 %. CONCLUSIONS The study demonstrated critical problems in antimicrobial prophylaxis management in surgical wards due to a lack of compliance between hospitals and national guidelines, a shortage of specific and updated recommendations for some surgical interventions and incorrect local specific procedures. Coordination between local and national recommendations, strengthening of evidence based decisions and continuous sharing of policy updates are needed.
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Affiliation(s)
- Marco Testa
- School of specialization in Hygiene and Preventive Medicine, Turin, Italy. .,Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - Michela Stillo
- School of specialization in Hygiene and Preventive Medicine, Turin, Italy.,Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Sebastian Giacomelli
- School of specialization in Hygiene and Preventive Medicine, Turin, Italy.,Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Silvia Scoffone
- School of specialization in Hygiene and Preventive Medicine, Turin, Italy.,Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | | | - Enzo Carlo Farina
- Department of General Surgery, City of Science and Health, Turin, Italy
| | - Carla Maria Zotti
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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Reutter F, Reuter DA, Hilgarth H, Heilek AM, Goepfert MS, Punke MA. [Perioperative antibiotic prophylaxis]. Anaesthesist 2015; 63:73-86. [PMID: 24402512 DOI: 10.1007/s00101-013-2282-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In times of growing bacterial resistance against antimicrobiotic drugs the broad prescription of antibiotics in human medicine must be carefully considered. The perioperative antibiotic treatment is in the center of that conflict. On the one hand an efficient pathogen reduction for the preemptive treatment of infectious complications is desired but on the other hand it is suspected that this promotes the selection of multiresistant pathogens which could lead to an increase of more complicated nosocomial infections. The aim of this article is a critical appraisal of this subject on the basis of the 2012 guidelines of the German working group of Hygiene in Hospital and Practice (AWMF) and the 2010 recommendations of the Paul-Ehrlich-Gesellschaft.
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Affiliation(s)
- F Reutter
- Zentrum für Anästhesiologie und Intensivmedizin, Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Economic evaluation of appropriate duration of antibiotic prophylaxis for prevention of neurosurgical infections in a middle-income country. Am J Infect Control 2015; 43:44-7. [PMID: 25564123 DOI: 10.1016/j.ajic.2014.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/05/2014] [Accepted: 09/08/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Preoperative antibiotic prophylaxis is one of the preventive measures for surgical site infections (SSIs). Very little data about the cost effectiveness of the appropriate duration of antibiotic prophylaxis in low- and middle-income countries are available. We aim to assess the cost effectiveness of the use of antibiotic prophylaxis for <24 hours to prevent neurosurgical infections in a middle-income country, Turkey. METHODS A 1-year prospective study was performed between June 2012 and June 2013. During this study period patients were followed-up on for the development of SSI by means of hospital and postdischarge surveillance. Patients included in the study group received appropriate duration of antibiotic prophylaxis (<24 hours), and the duration of prophylaxis was longer in the control group. The antibiotic costs per patient, including prophylaxis and treatment, were calculated. RESULTS A total of 822 operations consisting of craniotomy (n = 558), spinal fusion (n = 220), and ventricular shunt (n = 44) were included in the study. The study group included 488 (59.4%) patients who underwent operations with appropriate duration (<24 hours) of antibiotic prophylaxis. Prophylactic antibiotic cost per patient was significantly lower in the study group ($3.35 and $20.41, respectively). The SSI rates did not differ between the 2 groups: 3.5% (17/488) in the study group and 3.6 (12/822) in the control group (P > .05). CONCLUSION This cost-analysis study demonstrates that prolonged antibiotic prophylaxis correlates with increased burden of cost, but it is not preventive for SSI.
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Liu W, Ni M, Zhang Y, Groen RJM. Antibiotic prophylaxis in craniotomy: a review. Neurosurg Rev 2014; 37:407-14; discussion 414. [PMID: 24526365 DOI: 10.1007/s10143-014-0524-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 08/24/2013] [Accepted: 10/27/2013] [Indexed: 11/24/2022]
Abstract
The effectiveness of antibiotic prophylaxis (AP) in craniotomies has been clarified through the accumulation of evidence and increased antibiotic knowledge. This paper focuses on the use of AP in craniotomies during different historical periods and collects highly relevant evidence on this issue. This review surveys different AP guidelines and explains why cefazolin was selected by most guidelines. Recent prominent topics, including strategies to update and implement guidelines and antibiotic efficacy in postoperative meningitis and surveillance and decolonization therapies for methicillin-resistant Staphylococcus aureus, are discussed.
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Affiliation(s)
- Weiming Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050, Beijing, China,
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Adherence of surgeons to antimicrobial prophylaxis guidelines in a tertiary general hospital in a rapidly developing country. Adv Pharmacol Sci 2013; 2013:842593. [PMID: 24454349 PMCID: PMC3885161 DOI: 10.1155/2013/842593] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/02/2013] [Indexed: 12/04/2022] Open
Abstract
Objectives. To assess the standard practice of care of surgeons regarding surgical antibiotic prophylaxis, to identify gaps, and to set recommendations. Methods. A retrospective analysis of data obtained from different surgical units in a single center in Qatar over a 3-month period in 2012. A total of 101 patients who underwent surgery and followed regimes for surgical prophylaxis as per hospital guidelines were included in the study. Results. The overall use of antibiotic was 89%, whereas the current practice did not match the recommended hospital protocols in 53.5% of cases. Prolonged antibiotics use (59.3%) was the commonest reason for nonadherence followed by the use of an alternative antibiotic to that recommended in the protocol (31.5%) and no prophylaxis was used in 9.2% of cases. The rate of compliance was significantly higher among clean surgery than clean contaminated group (P = 0.03). Forty-four percent of clean and 65% of clean-contaminated procedures showed noncompliance with the recommended surgical antimicrobial prophylaxis hospital guidelines. Conclusion. Lack of adherence to hospital protocols is not uncommon. This finding remains a challenge to encourage clinicians to follow hospital guidelines appropriately and to consistently apply the surgical antibiotic prophylaxis. The role of clinical pharmacist may facilitate this process across all surgical disciplines.
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Napolitano F, Izzo MT, Di Giuseppe G, Angelillo IF. Evaluation of the appropriate perioperative antibiotic prophylaxis in Italy. PLoS One 2013; 8:e79532. [PMID: 24236142 PMCID: PMC3827374 DOI: 10.1371/journal.pone.0079532] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/02/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The appropriate use of antibiotics prophylaxis in the prevention and reduction in the incidence of surgical site infection is widespread. This study evaluates the appropriateness of the prescription of antibiotics prophylaxis prior to surgery amongst hospitalized patients in the geographic area of Avellino, Caserta, and Naples (Italy) and the factors associated with a poor adherence. METHODS A sample of 382 patients admitted to 23 surgical wards and undergoing surgery in five hospitals were randomly selected. RESULTS Perioperative antibiotic prophylaxis was appropriate in 18.1% of cases. The multivariate logistic regression analysis showed that patients with hypoalbuminemia, with a clinical infection, with a wound clean were more likely to receive an appropriate antibiotic prophylaxis. Compared with patients with an American Society of Anesthesiologists (ASA) score ≥4, those with a score of 2 were correlated with a 64% reduction in the odds of having an appropriate prophylaxis. The appropriateness of the timing of prophylactic antibiotic administration was observed in 53.4% of the procedures. Multivariate logistic regression model showed that such appropriateness was more frequent in older patients, in those admitted in general surgery wards, in those not having been underwent an endoscopic surgery, in those with a higher length of surgery, and in patients with ASA score 1 when a score ≥4 was chosen as the reference category. The most common antibiotics used inappropriately were ceftazidime, sultamicillin, levofloxacin, and teicoplanin. CONCLUSIONS Educational interventions are needed to improve perioperative appropriate antibiotic prophylaxis.
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Affiliation(s)
| | - Maria Teresa Izzo
- Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | | | - Italo F. Angelillo
- Department of Experimental Medicine, Second University of Naples, Naples, Italy
- * E-mail:
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Antibiotic stewardship in Germany: a cross-sectional questionnaire survey of 355 intensive care units. Infection 2013; 42:119-25. [PMID: 24135909 DOI: 10.1007/s15010-013-0531-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/04/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE Little information is available on antibiotic prescription management in German hospitals. The objective of this cross-sectional study was to determine the prevalence and components of antibiotic stewardship measures in German intensive care units (ICUs). METHODS A questionnaire survey was sent to all ICUs participating in the German nosocomial infection surveillance system (n = 579) in October 2011. Data on antibiotic management structures were collected and analyzed by structural hospital and ICU factors. RESULTS The questionnaire was completed by 355 German ICUs (response rate 61 %). Common measures used (>80 % of the ICUs) were personnel restrictions for antibiotic prescriptions, routine access to bacterial resistance data, and pharmacy reports on antibiotic costs and consumption. A small proportion of ICUs (14 %) employed physicians specialized in the prescription of antimicrobial medication. Hospitals with their own microbiological laboratory report participation in surveillance networks for antimicrobial use (34 %) and bacterial resistance (32 %) twice as often as hospitals with external laboratories (15 and 14 %, respectively, p < 0.001). Also, non-profit and public hospitals participate more often in surveillance networks for bacterial resistance than private hospitals (>23 % vs. 11 %, p < 0.05). CONCLUSIONS While the majority of ICUs report to have some antibiotic policies established, the contents and composition of these policies vary. Organizational-level control strategies to improve antibiotic management are common in Germany. However, strategies widely considered effective, such as the systematic cross-institutional surveillance of antimicrobial use and bacterial resistance in a standardized manner or the employment of infectious disease specialists, are scarce. This study provides a benchmark for future antibiotic stewardship programs.
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