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Morioka H, Koizumi Y, Watariguchi T, Oka K, Tomita Y, Kojima Y, Okudaira M, Ito Y, Shimizu J, Watamoto K, Kato H, Nagaoka M, Yokota M, Hasegawa C, Tsuji T, Shimizu S, Ito K, Kawasaki S, Akita K, Kitagawa Y, Mutoh Y, Ishihara M, Iwata S, Nozaki Y, Nozawa M, Kato M, Katayama M, Yagi T. Surgical antimicrobial prophylaxis in Japanese hospitals: Real status and challenges. J Infect Chemother 2024; 30:626-632. [PMID: 38272262 DOI: 10.1016/j.jiac.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/24/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Information regarding the status of surgical antimicrobial prophylaxis (SAP) in Japanese hospitals is lacking. This study aimed to explore the status of SAP prescriptions for surgeries and adherence to Japanese SAP guidelines. METHODS From February to July 2020, a 1-day multicentre point prevalent survey was conducted at 27 hospitals in Aichi Prefecture, Japan. Patients prescribed SAP were included in this study. The appropriateness of the SAP was evaluated based on the guidelines for selection of antimicrobials and their duration. Surgery was defined as appropriate when all the items were appropriate. RESULTS A total of 728 patients (7.1 %; 728/10,199) received antimicrobials for SAP. Among them, 557 patients (76.5 %, 557/728) underwent the surgeries described in the guidelines. The overall appropriateness of all surgeries was 33.9 % (189/557). The appropriate selection of antimicrobial before/during and after surgery and their durations were 67.5 % (376/557), 67.5 % (376/557), and 43.3 % (241/557), respectively. The overall appropriateness ranged from 0 % (0/37, oral and maxillofacial surgery) to 58.7 % (88/150, orthopaedic surgery) and 27.7 % (36/130, community hospitals with 400-599 beds) to 47.2 % (17/36, specific hospitals). Cefazolin was the most prevalent antimicrobial prescribed before/during (55.5 %, 299/539), and after (45.1 %, 249/552) surgery. In total, 101 oral antimicrobials were prescribed postoperatively. CONCLUSIONS SAP adherence by specific surgical fields and hospitals was shown in this study. Intensive intervention and repeated surveillance are necessary to improve SAP prescriptions in Japanese hospitals.
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Affiliation(s)
- Hiroshi Morioka
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan.
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute, Japan; Department of Infection Prevention and Control, Wakayama Medical University, Wakayama, Japan
| | | | - Keisuke Oka
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan; Antimicrobial Stewardship Team, Kariya Toyota General Hospital, Kariya, Japan
| | - Yuka Tomita
- Department of Infectious Diseases, Japanese Red Cross Aichi Medical Centre Nagoya Daini Hospital, Nagoya, Japan
| | - Yumi Kojima
- Infection Control Team, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | | | - Yuji Ito
- Department of Respiratory Medicine, Daiyukai General Hospital, Ichinomiya, Japan
| | - Junichi Shimizu
- Department of Thoracic Oncology, Aichi Cancer Centre Hospital, Nagoya, Japan
| | - Koichi Watamoto
- Department of Hematology, Komaki City Hospital, Komaki, Japan
| | - Hiroki Kato
- Department of Infectious Diseases, Toyota Memorial Hospital, Toyota, Japan
| | | | - Manabu Yokota
- Department of Pharmacy, Handa City Hospital, Handa, Japan
| | - Chihiro Hasegawa
- Department of Infectious Diseases, Nagoya City East Medical Centre, Nagoya, Japan
| | - Takeshi Tsuji
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Japan
| | - Shinsuke Shimizu
- Infection Control Team, Kamiiida Daiichi General Hospital, Nagoya, Japan
| | - Kenta Ito
- Department of General Pediatrics, Aichi Children's Health and Medical Centre, Obu, Japan
| | - Shohei Kawasaki
- Department of Pharmacy, Nishichita General Hospital, Tokai, Japan
| | - Kenji Akita
- Department of Respiratory Medicine, Nagoya City University West Medical Centre, Nagoya, Japan
| | - Yuichi Kitagawa
- Department of Infection Control, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Yoshikazu Mutoh
- Department of Infectious Diseases, Tosei General Hospital, Seto, Japan
| | | | - Susumu Iwata
- Department of Respiratory Medicine, Kasugai Municipal Hospital, Kasugai, Japan
| | - Yasuhiro Nozaki
- Department of Respiratory Medicine, Tokoname Municipal Hospital, Tokoname, Japan
| | | | - Munehiro Kato
- Department of Respiratory Medicine, Asahi Rosai Hospital, Owariasahi, Japan
| | - Masao Katayama
- Department of Internal Medicine and Rheumatology and Department of Infection Control Team, NHO Nagoya Medical Center, Nagoya, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan
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Long DR, Cifu A, Salipante SJ, Sawyer RG, Machutta K, Alverdy JC. Preventing Surgical Site Infections in the Era of Escalating Antibiotic Resistance and Antibiotic Stewardship. JAMA Surg 2024:2820522. [PMID: 38922606 DOI: 10.1001/jamasurg.2024.0429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Importance According to the Centers for Disease Control and Prevention and governing bodies within the American College of Surgeons, the administration of antibiotics as prophylaxis against infection prior to a planned elective procedure is, with rare exception, routinely recommended. The goal of "getting to zero" infections remains a high priority for policymakers, practitioners, and certainly for patients. Observations Despite the many advances in surgical technique, skin decontamination, sterile procedure, and enhanced recovery programs, surgical site infections continue to adversely affect procedures as diverse as dental implant surgery, joint arthroplasty, and major abdominal surgery. Although surgical site infection rates are at historically low levels, progress has stalled in recent reporting periods and such infections remain disabling, costly, and occasionally lethal. Stakeholders in the field, including surgeons, infectious diseases specialists, and industry, advocate for strategies emphasizing greater levels of intraoperative sterility or broader-spectrum antibiotic coverage as the most appropriate path forward. Conclusions and Relevance The current emphasis on ever-increasing levels of intraoperative sterility and extended-spectrum antibiotic use are not sustainable long-term solutions. Continuing to escalate these approaches may contribute to unintended consequences including antimicrobial resistance. Principles of antimicrobial stewardship and microbiome sciences can be applied to inform a more effective and sustainable approach to infection prevention in the field of surgery.
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Affiliation(s)
- Dustin R Long
- Division of Critical Care Medicine, Department of Anesthesiology & Pain Medicine, University of Washington, Seattle
| | - Adam Cifu
- Department of Internal Medicine, University of Chicago, Chicago, Illinois
| | - Stephen J Salipante
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle
| | - Robert G Sawyer
- Department of Surgery, Western Michigan University Homer Stryker School of Medicine, Kalamazoo
| | | | - John C Alverdy
- Department of Surgery, University of Chicago, Chicago, Illinois
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Jamaluddin NAH, Periyasamy P, Lau CL, Ponnampalavanar S, Lai PSM, Loong LS, Tg Abu Bakar Sidik TMI, Ramli R, Tan TL, Kori N, Yin MK, Azman NJ, James R, Thursky K, Naina Mohamed I. Assessment of antimicrobial prescribing patterns, guidelines compliance, and appropriateness of antimicrobial prescribing in surgical-practice units: point prevalence survey in Malaysian teaching hospitals. Front Pharmacol 2024; 15:1381843. [PMID: 38720771 PMCID: PMC11076853 DOI: 10.3389/fphar.2024.1381843] [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: 02/04/2024] [Accepted: 03/28/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives: This study sought to investigate the quality of antimicrobial prescribing among adult surgical inpatients besides exploring the determinants of non-compliance and inappropriate prescribing to inform stewardship activities. Methods: A cross-sectional point prevalence study employing Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) was conducted in April 2019 at two teaching hospitals in Malaysia. Results: Among 566 surgical inpatients, 44.2% were receiving at least one antimicrobial, for a total of 339 prescriptions. Antimicrobials belonging to the World Health Organization's Watch group were observed in 57.8% of cases. Both hospitals exhibited similar types of antimicrobial treatments prescribed and administration routes. A significant difference in antimicrobial choice was observed between hospitals (p < 0.001). Hospital with electronic prescribing demonstrated better documentation practice (p < 0.001). Guidelines compliance, 32.8% (p = 0.952) and appropriateness, 55.2% (p = 0.561) did not significantly differ. The major contributors of inappropriateness were incorrect duration, (15%) and unnecessary broad-spectrum coverage, (15.6%). Non-compliance and inappropriate prescribing were found to be 2 to 4 times significantly higher with antimicrobial prophylaxis prescription compared to empirical therapy. Conclusion: Antimicrobial stewardship efforts to improve appropriate surgical prescribing are essential. These initiatives should prioritize surgical prophylaxis prescribing, focusing on reducing unnecessarily prolonged use and broad-spectrum antimicrobials, raising awareness among prescribers and promoting proper documentation.
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Affiliation(s)
- Nurul Adilla Hayat Jamaluddin
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Department of Hospital and Clinical Pharmacy, Faculty of Pharmacy, University of Cyberjaya, Cyberjaya, Selangor, Malaysia
| | - Petrick Periyasamy
- Medical Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chee Lan Lau
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Pharmacy Department, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | | | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- School of Medical and Life Sciences, Sunway University, Petaling Jaya, Selangor, Malaysia
| | - Ly Sia Loong
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tg Mohd Ikhwan Tg Abu Bakar Sidik
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ramliza Ramli
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Toh Leong Tan
- Emergency Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Najma Kori
- Medical Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mei Kuen Yin
- Pharmacy Department, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Nur Jannah Azman
- Pharmacy Department, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Rodney James
- The Royal Melbourne Hospital, Melbourne, Australia
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Australia
| | - Karin Thursky
- The Royal Melbourne Hospital, Melbourne, Australia
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Australia
| | - Isa Naina Mohamed
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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4
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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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Ayhan M, Coşkun B, Kayaaslan B, Hasanoğlu İ, Kalem AK, Eser F, Bilir YA, Ünlü S, Güner R. Point prevalence of antibiotic usage in major referral hospital in Turkey. PLoS One 2024; 19:e0296900. [PMID: 38295065 PMCID: PMC10830045 DOI: 10.1371/journal.pone.0296900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/21/2023] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION The most important and undesirable consequence of inappropriate antibiotic use is the spread of antibiotic resistance, increased adverse effects, increased mortality and healthcare costs. We aimed to assess antibiotic usage characteristics in inpatient setting in our center. MATERIALS AND METHODS A one-day, single center point-prevalence study was carried out on June 9th 2021, in Ankara City Hospital in Turkey. Data of antibiotic consumption, appropriateness of usage and predictors of inappropriate use in adult patients were evaluated. RESULTS Out of 2640 adult patients, 893 (33.8%) were receiving at least one antibiotic. A total of 1212 antibiotic prescriptions with an average of 1.44±0.64 were found. Antibiotics were most commonly used for therapeutic purpose (84.7%), followed by surgical prophylaxis (11.6%). Majority of therapeutically used antibiotics were empirical (67.9%). Infectious diseases consultation was present in 68.3% with a compliance rate of 95.7%. Rate of inappropriate use was 20%. The most frequent cause of inappropriateness was unnecessary use (52.5%). Most commonly and most inappropriately used antibiotics were carbapenems (17.5%) and first generation cephalosporins (38.7%), respectively. Most of the inappropriateness observed in first-generation cephalosporins was due to inappropriate longer surgical prophylaxis. While age is an independent risk factor for inappropriate antibiotic use (p = 0.042), COVID-19 unit admission, use for therapeutic purpose and infectious diseases consultation were protective factors (p<0.001, p<0.001, p<0.001). CONCLUSION Rate of inappropriate use was low, but inappropriate surgical prophylaxis remains an important problem in surgical units. There is a considerable need to implement an antimicrobial stewardship program that focuses on surgical prophylaxis practices.
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Affiliation(s)
- Müge Ayhan
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Belgin Coşkun
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - İmran Hasanoğlu
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Kaya Kalem
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Yeşim Aybar Bilir
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Serpil Ünlü
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
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Sartelli M, Coccolini F, Labricciosa FM, Al Omari AH, Bains L, Baraket O, Catarci M, Cui Y, Ferreres AR, Gkiokas G, Gomes CA, Hodonou AM, Isik A, Litvin A, Lohsiriwat V, Kotecha V, Khokha V, Kryvoruchko IA, Machain GM, O’Connor DB, Olaoye I, Al-Omari JAK, Pasculli A, Petrone P, Rickard J, Sall I, Sawyer RG, Téllez-Almenares O, Catena F, Siquini W. Surgical Antibiotic Prophylaxis: A Proposal for a Global Evidence-Based Bundle. Antibiotics (Basel) 2024; 13:100. [PMID: 38275329 PMCID: PMC10812782 DOI: 10.3390/antibiotics13010100] [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: 12/21/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
In the multimodal strategy context, to implement healthcare-associated infection prevention, bundles are one of the most commonly used methods to adapt guidelines in the local context and transfer best practices into routine clinical care. One of the most important measures to prevent surgical site infections is surgical antibiotic prophylaxis (SAP). This narrative review aims to present a bundle for the correct SAP administration and evaluate the evidence supporting it. Surgical site infection (SSI) prevention guidelines published by the WHO, CDC, NICE, and SHEA/IDSA/APIC/AHA, and the clinical practice guidelines for SAP by ASHP/IDSA/SIS/SHEA, were reviewed. Subsequently, comprehensive searches were also conducted using the PubMed®/MEDLINE and Google Scholar databases, in order to identify further supporting evidence-based documentation. The bundle includes five different measures that may affect proper SAP administration. The measures included may be easily implemented in all hospitals worldwide and are based on minimal drug pharmacokinetics and pharmacodynamics knowledge, which all surgeons should know. Antibiotics for SAP should be prescribed for surgical procedures at high risk for SSIs, such as clean-contaminated and contaminated surgical procedures or for clean surgical procedures where SSIs, even if unlikely, may have devastating consequences, such as in procedures with prosthetic implants. SAP should generally be administered within 60 min before the surgical incision for most antibiotics (including cefazolin). SAP redosing is indicated for surgical procedures exceeding two antibiotic half-lives or for procedures significantly associated with blood loss. In principle, SAP should be discontinued after the surgical procedure. Hospital-based antimicrobial stewardship programmes can optimise the treatment of infections and reduce adverse events associated with antibiotics. In the context of a collaborative and interdisciplinary approach, it is essential to encourage an institutional safety culture in which surgeons are persuaded, rather than compelled, to respect antibiotic prescribing practices. In that context, the proposed bundle contains a set of evidence-based interventions for SAP administration. It is easy to apply, promotes collaboration, and includes measures that can be adequately followed and evaluated in all hospitals worldwide.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, 62100 Macerata, Italy;
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Unit, Pisa University Hospital, 56124 Pisa, Italy;
| | | | - AbdelKarim. H. Al Omari
- Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Lovenish Bains
- Department of General Surgery, Maulana Azad Medical College, New Delhi 110002, India;
| | - Oussama Baraket
- Department of General Surgery, Bizerte Hospital, Bizerte 7000, Tunisia;
| | - Marco Catarci
- General Surgery Unit, Sandro Pertini Hospital, 00157 Rome, Italy;
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300052, China;
| | - Alberto R. Ferreres
- Department of Surgery, University of Buenos Aires, Buenos Aires 1428, Argentina;
| | - George Gkiokas
- Department of Surgery, Medical School, “Aretaieio” Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Carlos Augusto Gomes
- Department of Surgery, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Hospital Universitário Terezinha de Jesus, Juiz de Fora 25520, Brazil;
| | - Adrien M. Hodonou
- Department of Surgery, Faculty of Medicine, University of Parakou, Parakou 03 BP 10, Benin;
| | - Arda Isik
- Department of Surgery, Istanbul Medeniyet University, Istanbul 34000, Turkey;
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, 246000 Gomel, Belarus;
| | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Vihar Kotecha
- Department of General Surgery, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Vladimir Khokha
- General Surgery Unit, Podhalanski Specialized Hospital, 34-400 Nowy Targ, Poland;
| | - Igor A. Kryvoruchko
- Department of Surgery No. 2, Kharkiv National Medical University, 61000 Kharkiv, Ukraine;
| | - Gustavo M. Machain
- Department of Surgery, Universidad Nacional de Asuncion, San Lorenzo 1055, Paraguay;
| | - Donal B. O’Connor
- Department of Surgery, School of Medicine, Trinity College, D02 PN40 Dublin, Ireland;
| | - Iyiade Olaoye
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin 240101, Nigeria;
| | - Jamal A. K. Al-Omari
- Medical College, Al-Balqa Applied University, Al-Hussein Hospital, Zarqa 13313, Jordan;
| | - Alessandro Pasculli
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Unit of Academic General Surgery “V. Bonomo”, University of Bari “A. Moro”, 70125 Bari, Italy;
| | - Patrizio Petrone
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital—Long Island, Mineola, NY 11501, USA;
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Dakar 3006, Senegal;
| | - Robert G. Sawyer
- Department of Surgery, School of Medicine, Western Michigan University, Kalamazoo, MI 49008, USA;
| | - Orlando Téllez-Almenares
- General Surgery Department of Saturnino Lora Provincial Hospital, University of Medical Sciences of Santiago de Cuba,
26P2+J7X, Santiago de Cuba 90100, Cuba;
| | - Fausto Catena
- Department of Surgery, “Bufalini” Hospital, 47521 Cesena, Italy;
| | - Walter Siquini
- Department of Surgery, Macerata Hospital, 62100 Macerata, Italy;
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7
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Im H, Oh SY, Lim L, Lee H, Kwon J, Ryu HG. Timing of prophylactic antibiotics administration and suspected systemic infection after percutaneous biliary intervention. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024; 31:34-41. [PMID: 37792597 DOI: 10.1002/jhbp.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND/PURPOSE Prophylactic antibiotics administration before percutaneous biliary intervention (PBI) is currently recommended, but the underlying evidence is mostly extrapolated from prophylactic antibiotics before surgery. The aim of this study was to evaluate the impact of prophylactic antibiotics administration timing on the incidence of suspected systemic infection after PBI. METHODS The incidence of suspected systemic infection after PBI was compared in patients who received prophylactic antibiotics at four different time intervals between antibiotics administration and skin puncture for PBI. Suspected post-intervention systemic infection was assessed according to predetermined clinical criteria. RESULTS There were 98 (21.6%) suspected systemic infections after 454 PBIs in 404 patients. There were significant differences among the four groups in the incidence of suspected systemic infection after the intervention (p = .020). Fever was the most common sign of suspected systemic infection. Administration of prophylactic antibiotics more than an hour before PBI was identified as an independent risk factor of suspected systemic infection after adjusting for other relevant factors (adjusted odds ratio = 10.54; 95% confidence interval, 1.40-78.86). CONCLUSIONS The incidence of suspected systemic infection after the PBI was significantly lower when prophylactic antibiotics were administered within an hour before the intervention.
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Affiliation(s)
- Hyunjae Im
- Department of Critical Care Medicine, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Young Oh
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Leerang Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hannah Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jina Kwon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Geol Ryu
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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8
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Tunio S, Dzioba A, Dhami R, Elsayed S, Strychowsky JE. Auto-Substitutions to Optimize Perioperative Antimicrobial Prophylaxis: Pre-Post Intervention Study. Laryngoscope 2023; 133:3403-3408. [PMID: 37159098 DOI: 10.1002/lary.30740] [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: 12/01/2022] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Appropriate administration of perioperative antibiotics can prevent antimicrobial resistance, adverse drug events, surgical site infections, and increased costs to the health care system for many surgeries in Otolaryngology-Head and Neck Surgery (OHNS). OBJECTIVE The objective of the study is to achieve 90% compliance with evidence-based perioperative antibiotic prophylaxis guidelines among elective surgical procedures in OHNS. METHODS The pre-intervention group consisted of patients undergoing elective surgical procedures in the 13 months prior to the interventions (September 2019-2020) whereas the post-intervention group comprised patients undergoing elective procedures during the 8 months following the implementation (October 2020-May 2021). The 4 Es of knowledge translation and the Donabedian framework were used to frame the study. Components of the intervention included educational grand rounds and automatic substitutions in electronic health records. In June 2021, a survey of staff and residents assessed the self-reported perception of following evidence-based guidelines. RESULTS Compliance with antimicrobial prophylaxis guidelines were evaluated based on agent and dose. The overall compliance improved from 38.8% pre-intervention to 59.0% post-intervention (p < 0.001). Agent compliance did not improve from pre- to post-intervention, that is, 60.7% to 62.8%, respectively, (p = 0.68), whereas dose compliance improved from 39.6% to 89.2% (p < 0.001). Approximately 78.5% of survey respondents felt that they strongly agreed or agreed with always following evidence-based antimicrobial prophylaxis guidelines. CONCLUSION Compliance with antimicrobial prophylaxis guidelines improved, primarily due to increased dosing compliance. Future interventions will target agent compliance and selected procedures with lower compliance rates. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3403-3408, 2023.
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Affiliation(s)
- Suhaima Tunio
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Rita Dhami
- Department of Pharmacy, London Health Sciences Centre, London, Ontario, Canada
- Department of Health Sciences, Western University, London, Ontario, Canada
| | - Sameer Elsayed
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Pathology & Laboratory Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Julie E Strychowsky
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
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Kostourou S, Samiotis I, Dedeilias P, Charitos C, Papastamopoulos V, Mantas D, Psichogiou M, Samarkos M. Effect of an E-Prescription Intervention on the Adherence to Surgical Chemoprophylaxis Duration in Cardiac Surgery: A Single Centre Experience. Antibiotics (Basel) 2023; 12:1182. [PMID: 37508278 PMCID: PMC10376074 DOI: 10.3390/antibiotics12071182] [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: 06/14/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
In our hospital, adherence to the guidelines for peri-operative antimicrobial prophylaxis (PAP) is suboptimal, with overly long courses being common. This practice does not offer any incremental benefit, and it only adds to the burden of antimicrobial consumption, promotes the emergence of antimicrobial resistance, and it is associated with adverse events. Our objective was to study the effect of an electronic reminder on the adherence to each element of PAP after cardiac surgery. We conducted a single center, before and after intervention, prospective cohort study from 1 June 2014 to 30 September 2017. The intervention consisted of a reminder of the hospital guidelines when ordering PAP through the hospital information system. The primary outcome was adherence to the suggested duration of PAP, while secondary outcomes included adherence to the other elements of PAP and incidence of surgical site infections (SSI). We have studied 1080 operations (400 pre-intervention and 680 post-intervention). Adherence to the appropriate duration of PAP increased significantly after the intervention [PRE 4.0% (16/399) vs. POST 15.4% (105/680), chi-square p < 0.001]; however, it remained inappropriately low. Factors associated with inappropriate duration of PAP were pre-operative hospitalization for <3 days, and duration of operation >4 h, while there were significant differences between the chief surgeons. Unexpectedly, the rate of SSIs increased significantly during the study (PRE 2.8% (11/400) vs. POST 5.9% (40/680), chi-square p < 0.019). The implemented intervention achieved a relative increase in adherence to the guideline-recommended PAP duration; however, adherence was still unacceptably low and further efforts to improve adherence are needed.
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Affiliation(s)
- Sofia Kostourou
- Infection Prevention Unit, Evaggelismos Hospital, 10676 Athens, Greece
| | - Ilias Samiotis
- Department of Cardiac Thoracic and Vascular Surgery, Evaggelismos Hospital, 10676 Athens, Greece
| | - Panagiotis Dedeilias
- Department of Cardiac Thoracic and Vascular Surgery, Evaggelismos Hospital, 10676 Athens, Greece
| | - Christos Charitos
- Department of Cardiac Thoracic and Vascular Surgery, Evaggelismos Hospital, 10676 Athens, Greece
| | | | - Dimitrios Mantas
- 2nd Propaedeutic Department of Surgery, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Mina Psichogiou
- 1st Department of Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Michael Samarkos
- 1st Department of Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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10
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Cabral SM, Harris AD, Cosgrove SE, Magder LS, Tamma PD, Goodman KE. Adherence to Antimicrobial Prophylaxis Guidelines for Elective Surgeries Across 825 US Hospitals, 2019-2020. Clin Infect Dis 2023; 76:2106-2115. [PMID: 36774539 DOI: 10.1093/cid/ciad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND There are limited US data assessing adherence to surgical antimicrobial prophylaxis guidelines, particularly across a large, nationwide sample. Moreover, commonly prescribed inappropriate antimicrobial prophylaxis regimens remain unknown, hindering improvement initiatives. METHODS We conducted a retrospective cohort study of adults who underwent elective craniotomy, hip replacement, knee replacement, spinal procedure, or hernia repair in 2019-2020 at hospitals in the PINC AI (Premier) Healthcare Database. We evaluated adherence of prophylaxis regimens, with respect to antimicrobial agents endorsed in the American Society of Health-System Pharmacist guidelines, accounting for patient antibiotic allergy and methicillin-resistant Staphylococcus aureus colonization status. We used multivariable logistic regression with random effects by hospital to evaluate associations between patient, procedural, and hospital characteristics and guideline adherence. RESULTS Across 825 hospitals and 521 091 inpatient elective surgeries, 308 760 (59%) were adherent to prophylaxis guidelines. In adjusted analysis, adherence varied significantly by US Census division (adjusted OR [aOR] range: .61-1.61) and was significantly lower in 2020 compared with 2019 (aOR: .92; 95% CI: .91-.94; P < .001). The most common reason for nonadherence was unnecessary vancomycin use. In a post hoc analysis, controlling for patient age, comorbidities, other nephrotoxic agent use, and patient and procedure characteristics, patients receiving cefazolin plus vancomycin had 19% higher odds of acute kidney injury (AKI) compared with patients receiving cefazolin alone (aOR: 1.19; 95% CI: 1.11-1.27; P < .001). CONCLUSIONS Adherence to antimicrobial prophylaxis guidelines remains suboptimal, largely driven by unnecessary vancomycin use, which may increase the risk of AKI. Adherence decreased in the first year of the COVID-19 pandemic.
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Affiliation(s)
- Stephanie M Cabral
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anthony D Harris
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laurence S Magder
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katherine E Goodman
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA
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11
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Husi BA, Arnaldi L, Roitner M, Nolff MC. Retrospective evaluation of surgical site infection after open splenectomies with and without perioperative prophylactic antibiotic coverage. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2023; 51:154-160. [PMID: 37567177 DOI: 10.1055/a-2105-3593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
OBJECTIVES Perioperative prophylactic antibiotics (PPA) are widely used in veterinary medicine to prevent surgical site infections (SSI). Current guidelines advocate the use in clean procedures only if surgeries exceed 90 minutes, or in patients with an ASA score ≥3. Procedure specific recommendations are currently lacking. The following study aimed to analyze the protective effect of PPA in dogs undergoing open splenectomy. METHODS The electronic database of our institution was searched for dogs that underwent splenectomy between 10/2017 and 01/2023. Data collection included age at presentation, breed, weight, reason for splenectomy, diagnosis, ASA class, PPA regime, surgery time, anesthesia time, lowest blood oxygen concentration during anesthesia, lowest body temperature, and lowest blood pressure during surgery as well as duration of hospitalization. Dogs were included if a follow-up of 30 days after surgery was available, or if death occurred within this timeframe. RESULTS A total of 112 dogs were included. Of these, 46 dogs received PPA, and 66 did not. Most dogs were classified ASA 3 or higher (PPA 87%, non-PPA 80.3%). One SSI (1.5% SSI rate) occurred in the non-PPA group (overall SSI rate 0.9%). Due to the low SSI rate, statistical analysis of risk factors for SSI development was not possible. CONCLUSION The described infection rate of 1.5% without PPA indicates, that splenectomy does not qualify as high-risk surgery for SSI, even in patients with ASA class 3 or higher. CLINICAL RELEVANCE As splenectomies are frequently performed, the findings of the current study could have a major impact on the overall antimicrobial burden in routine veterinary practice.
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Affiliation(s)
- Benjamin Andrea Husi
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Laura Arnaldi
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Moritz Roitner
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Mirja Christine Nolff
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Switzerland
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12
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Gurunthalingam MP, Keche YN, Gaikwad NR, Dhaneria S, Singh MP. Appropriateness of Surgical Antibiotic Prophylaxis in a Tertiary Care Teaching Hospital in Central India: A Retrospective Analysis. Cureus 2023; 15:e38844. [PMID: 37303457 PMCID: PMC10256243 DOI: 10.7759/cureus.38844] [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] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Surgical antibiotic prophylaxis (SAP) has been a boon in the prevention of surgical site infections (SSIs). This study was conducted to assess and evaluate the selection, timing, and duration of administration of SAP and their compliance with national and international guidelines in a tertiary care teaching hospital in India. This retrospective study included the data collected from the central records department in a tertiary care teaching hospital on major surgeries conducted between January 1, 2018, and December 31, 2018, from the departments of ENT, general surgery, orthopedic surgery, and obstetrics and gynecology. The data was analyzed for the appropriateness of their indication for SAP administration, choice, timing, and duration of antibiotics, and compliance with the American Society of Health-System Pharmacists (ASHP) and Indian Council of Medical Research (ICMR) guidelines. Results and interpretation Out of the total 394 case records included, only 2.53% (n = 10) of the cases were given an appropriate antibiotic. The duration of SAP was appropriate only in 6.53% (n = 24), and the timing of SAP administration was appropriate only in 50.76% (n = 204). The most commonly used antibiotic was ceftriaxone (pre-operative 58.12% (n = 229) and post-operative 43.14% (n = 170)). Major inappropriateness was observed in the selection of antibiotics which may be attributed to the non-availability of cefazolin in the institute. The inappropriateness of the duration of the SAP may be attributed to the extra precautions taken by the treating physicians to prevent SSIs. The overall compliance of the surgical cases with respect to the ASHP and ICMR guidelines was less than 1%. Conclusion This study identified the lacuna between the guidelines for SAP and the clinical application of the same. It also identified the areas where quality improvement was needed which can be improved by implementing antimicrobial stewardship, especially the choice and the duration of SAP administration.
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Affiliation(s)
| | - Yogendra N Keche
- Pharmacology, All India Institute of Medical Sciences, Raipur, IND
| | - Nitin R Gaikwad
- Pharmacology, All India Institute of Medical Sciences, Raipur, IND
| | - Suryaprakash Dhaneria
- Pharmacology and Therapeutics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, IND
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13
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Singla R, Suri V, Veeramalla S, Shafiq N, Rohilla M, Kalra J. Ensuring Compliance with Surgical Antimicrobial Prophylaxis Policy in High-Volume Resource-Limited Settings: Integrated Measures from Inception to Audit. J Gynecol Surg 2023. [DOI: 10.1089/gyn.2022.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Affiliation(s)
- Rimpi Singla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Snigdha Veeramalla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaswinder Kalra
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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14
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Porter MW, Burdi W, Casavant JD, Eastment MC, Tulloch-Palomino LG. Association between duration of antimicrobial prophylaxis and postoperative outcomes after lumbar spine surgery. Infect Control Hosp Epidemiol 2022; 43:1873-1879. [PMID: 35166198 PMCID: PMC9753085 DOI: 10.1017/ice.2021.529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/01/2021] [Accepted: 12/17/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To describe the association between duration of antimicrobial prophylaxis (AMP) and 30-day surgical site infection (SSI), 7-day acute kidney injury (AKI), 90-day Clostridioides difficile infection (CDI), prolonged hospitalization, and 30-day reoperation after lumbar spine surgery for noninfectious indications, and to report adherence to current guidelines. DESIGN Survey. PARTICIPANTS AND SETTING The study cohort comprised 6,198 patients who underwent lumbar spine surgery for noninfectious indications across 137 Veterans' Health Administration surgery centers between 2016 and 2020. METHODS Used univariate and multivariate logistic regression to determine the association between type and duration of AMP with 30-day SSI, 7-day AKI, 90-day CDI, prolonged hospitalization, and 30-day reoperation. RESULTS Only 1,160 participants (18.7%) received the recommended duration of AMP. On multivariate analysis, the use of multiple prophylactic antimicrobials was associated with increased odds of 90-day CDI (adjusted odds ratio [aOR], 5.5; 95% confidence interval [CI], 1.1-28.2) and 30-day reoperation (aOR, 2.3; 95% CI, 1.2-4.4). Courses of antimicrobials ≥3 days were associated with increased odds of prolonged hospitalization (aOR,1.8; 95% CI, 1.4-2.3) and 30-day reoperation (aOR, 3.5; 95% CI, 2.2-5.7). In univariate analysis, increasing days of AMP was associated with a trend toward increasing odds of 90-day CDI (cOR, 1.4; 95% CI, 1.0-1.8 per additional day; P = .056). CONCLUSIONS Longer courses of AMP after lumbar spine surgery were associated with higher odds of CDI, prolonged hospitalization, and reoperation, but not with lower odds of SSI. However, adherence to the recommended duration of AMP is very low, hinting at a wide evidence-to-practice gap that needs to be addressed by spine surgeons and antimicrobial stewardship programs.
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Affiliation(s)
- Mary W. Porter
- Pharmacy Services, VA Puget Sound Health Care System, Seattle, Washington
| | - William Burdi
- Pharmacy Services, VA Puget Sound Health Care System, Seattle, Washington
| | | | - McKenna C. Eastment
- Hospital and Specialty Medicine, VA Puget Sound Health Care System, Seattle, Washington
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Luis G. Tulloch-Palomino
- Hospital and Specialty Medicine, VA Puget Sound Health Care System, Seattle, Washington
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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15
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Chen Q, Yu J, Huang P, Huang Y, Chen Q, Zhang Z, Wang S. Incidence, Clinical Features, and Association with Prognosis of Bloodstream Infection in Pediatric Patients After Percutaneous or Surgical Treatment for Ventricular Septal Defect or Atrial Septal Defect: A Retrospective Cohort Study. Infect Dis Ther 2022; 11:2219-2232. [PMID: 36242740 PMCID: PMC9669298 DOI: 10.1007/s40121-022-00702-z] [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: 05/20/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Bloodstream infection (BSI) may occur after cardiac procedures, but this has rarely been investigated specifically in pediatric patients after percutaneous or surgical treatment for ventricular septal defect (VSD) or atrial septal defect (ASD) with recent data. The current study aimed to investigate the incidence, clinical features, and association with prognosis of BSI in this patient population. METHODS Pediatric patients who received percutaneous or surgical procedure for VSD or ASD between 2010 and 2018 in a large children's hospital in China were retrospectively enrolled via the Pediatric Intensive Care database, but only those who had blood culture records within 24 h after the procedure and who had no prior positive blood culture records were included. BSI after the procedure was identified by reviewing blood culture records, and baseline characteristics associated with BSI were explored by univariable logistic regression. In-hospital mortality and length of hospitalization were studied as prognostic outcomes and compared between patients with and without BSI. RESULTS A total of 1340 pediatric patients were included. Among them, 46 (3.43%) patients had BSI within 24 h after the procedure, of which the majority (78.26%, 36/46) were caused by Gram-positive bacteria and 65.22% (30/46) had antibiotic-resistant organisms. Age [odds ratio (OR) 0.98 per 1-month increase, 95% confidence interval (CI) 0.97-1.00, P = 0.021] and antibiotic use within 72 h before the procedure (OR 1.81, 95% CI 1.00-3.26, P = 0.049) were statistically significantly associated with developing BSI. Compared with patients without BSI, there was no statistically significant difference in in-hospital mortality (0.00% versus 0.54%, P = 1.000), but patients with BSI had statistically significantly longer length of hospitalization (median 14.51 versus 12.94 days, P = 0.006), while the association was not statistically significant after adjustment for baseline characteristics by multivariable linear regression (β = 1.73, 95% CI -0.59 to 4.04, P = 0.144). CONCLUSION BSI is relatively uncommon in pediatric patients after procedures for VSD or ASD, but a younger age seems a risk factor. Developing BSI appears to be associated with increased length of hospitalization but not in-hospital mortality.
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Affiliation(s)
- Qinchang Chen
- Department of Pediatric Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Structural Heart Disease, No. 106, Zhongshan 2nd Road, Guangzhou, China
| | - Jinjin Yu
- Department of Pediatric Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Structural Heart Disease, No. 106, Zhongshan 2nd Road, Guangzhou, China
| | - Pingchuan Huang
- Department of Pediatric Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Structural Heart Disease, No. 106, Zhongshan 2nd Road, Guangzhou, China
| | - Yulu Huang
- Department of Pediatric Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Structural Heart Disease, No. 106, Zhongshan 2nd Road, Guangzhou, China
| | - Qingui Chen
- Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhiwei Zhang
- Department of Pediatric Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Structural Heart Disease, No. 106, Zhongshan 2nd Road, Guangzhou, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Shushui Wang
- Department of Pediatric Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Structural Heart Disease, No. 106, Zhongshan 2nd Road, Guangzhou, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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16
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Yehouenou CL, Soleimani R, Kpangon AA, Simon A, Dossou FM, Dalleur O. Carbapenem-Resistant Organisms Isolated in Surgical Site Infections in Benin: A Public Health Problem. Trop Med Infect Dis 2022; 7:tropicalmed7080200. [PMID: 36006292 PMCID: PMC9414794 DOI: 10.3390/tropicalmed7080200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
An alarming worldwide increase in antimicrobial resistance is complicating the management of surgical site infections (SSIs), especially in low-middle income countries. The main objective of this study was to describe the pattern of carbapenem-resistant bacteria in hospitalized patients and to highlight the challenge of their detection in Benin. We collected pus samples from patients suspected to have SSIs in hospitals. After bacterial identification by MALDI-TOF mass spectrometry, antimicrobial susceptibility was performed according to the Kirby–Bauer method. Carbapenem-resistant strains were characterized using, successively, the Modified Hodge Test (MHT), the RESIST-5 O.K.N.V.I: a multiplex lateral flow and finally the polymerase chain reaction. Six isolates were resistant to three tested carbapenems and almost all antibiotics we tested but remained susceptible to amikacin. Four (66.7%) of them harbored some ESBL genes (blaCTX-M-1 and blaTEM-1). The MHT was positive for Carbapenems but not for Pseudomonas aeruginosa and Acinetobacter baumannii. As surgical antimicrobial prophylaxis, five of the six patients received ceftriaxone. The following carbapenems genes were identified: bla OXA-48(33.3%, n = 2), blaNDM (33.3%, n = 2) and blaVIM (33.3%, n = 2). These findings indicate a need for local and national antimicrobial resistance surveillance and the strengthening of antimicrobial stewardship programs in the country.
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Affiliation(s)
- Carine Laurence Yehouenou
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Avenue Emmanuel Mounier 73, 1200 Brussels, Belgium
- Laboratoire de Référence des Mycobactéries (LRM), Cotonou BP 817, Benin
- Faculté des Sciences de la Santé (FSS), Université d’Abomey Calavi (UAC), Cotonou BP 526, Benin
- Correspondence:
| | - Reza Soleimani
- Department of Laboratory Medicine, CHU UCL Namur, 5530 Yvoir, Belgium
| | - Arsène A. Kpangon
- Ecole nationale des Techniciens Supérieurs en Santé Publique et Surveillance Epidémiologique, Université de Parakou, Parakou BP 123, Benin
| | - Anne Simon
- Centres hospitaliers Jolimont, Prévention et Contrôle des infections, Groupe Jolimont asbl, Rue Ferrer, 7100 Haine-Saint-Paul, Belgium
| | - Francis M. Dossou
- Department of Surgery and Surgical Specialties, Faculty of Health Sciences, Campus Universitaire, Champs de Foire, Cotonou BP 188, Benin
| | - Olivia Dalleur
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Avenue Emmanuel Mounier 73, 1200 Brussels, Belgium
- Pharmacy, Clinique universitaire Saint-Luc, Université catholique de Louvain, UCLouvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
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17
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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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Morioka H, Ohge H, Nagao M, Kato H, Kokado R, Yamada K, Yamada T, Shimono N, Nukui Y, Yoshihara S, Sakamaki I, Nosaka K, Kubo Y, Kawamura H, Fujikura Y, Kitaura T, Sunakawa M, Yagi T. Appropriateness of surgical antimicrobial prophylaxis in Japanese university hospitals. J Hosp Infect 2022; 129:189-197. [PMID: 35835283 DOI: 10.1016/j.jhin.2022.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to determine the adherence to the Japanese surgical antimicrobial prophylaxis (SAP) guidelines in Japanese university hospitals. DESIGN A retrospective cohort study. SETTING Fifteen general and one dental university hospitals. METHODS We evaluated up to three cases of 18 designated surgeries regarding adherence to Japanese SAP guidelines: selection of antibiotics, timing of administration, re-dosing intervals, and duration of SAP. When all items were appropriate, surgery was defined as 'appropriate.' RESULTS In total, 688 cases (22-45 cases per surgery) were included. The overall appropriateness was 46.8% (322/688), and the appropriateness of each surgery ranged from 8.0% (2/25, cardiac implantable electronic device implantation) to 92.1% (35/38, distal gastrectomy). The appropriateness of each item was as follows: pre/intraoperative selections, 78.5% (540/688); timing of administrations, 96.0% (630/656); re-dosing intervals, 91.8% (601/656); postoperative selection, 78.9% (543/688); and duration of SAP, 61.4% (423/688). The overall appropriateness of hospitals ranged from 17.6% (9/51) to 73.3% (33/45). The common reasons for inappropriateness were the longer duration (38.5%, 265/688) and choice of antibiotics with a non-optimal antimicrobial spectrum before/during, and after surgery (19.0%, 131/688 and 16.8%, 116/688, respectively), compared to the guideline. CONCLUSIONS Adherence to the guidelines differed greatly between the surgeries and hospitals. Large-scale multicentre surveillance of SAP in Japanese hospitals is necessary to identify inappropriate surgeries, factors related to the appropriateness, and incidences of surgical site infections.
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Affiliation(s)
- Hiroshi Morioka
- Nagoya University Hospital, Department of Infectious Diseases, Nagoya, Japan.
| | - Hiroki Ohge
- Hiroshima University, Project Research Center for Nosocomial Infectious Diseases, Hiroshima, Japan
| | - Miki Nagao
- Kyoto University Graduate School of Medicine, Department of Clinical Laboratory Medicine, Kyoto, Japan
| | - Hideaki Kato
- Yokohama City University Hospital, Infection Prevention and Control Department, Yokohama, Japan
| | - Ryohei Kokado
- Osaka University Hospital, Division of Infection Control and Prevention, Suita, Japan
| | - Koichi Yamada
- Osaka Metropolitan University, Graduate School of Medicine, Department of Infection Control Science, Osaka, Japan
| | - Takahiro Yamada
- Hamamatsu University School of Medicine, Department of Hospital Pharmacy, Hamamatsu, Japan
| | - Nobuyuki Shimono
- Kyushu University Hospital, Center for the Study of Global Infection, Fukuoka, Japan
| | - Yoko Nukui
- Tokyo Medical and Dental University Hospital, Department of Infection Control and Prevention, Bunkyo City, Japan; Kyoto Prefectural University of Medicine, Department of Infection Control and Laboratory Medicine
| | - Shingo Yoshihara
- Nara Medical University, Center for Infectious Diseases, Kashihara, Japan
| | - Ippei Sakamaki
- Toyama University Hospital, Department of Clinical Infectious Diseases, Toyama, Japan
| | - Kisato Nosaka
- Kumamoto University Hospital, Department of Hematology, Rheumatology and Infectious Disease, Kumamoto, Japan
| | - Yuko Kubo
- Hiroshima University Hospital, Department of Pharmaceutical Services, Hiroshima, Japan
| | - Hideki Kawamura
- Kagoshima University Hospital, Department of Infection Control and Prevention, Kagoshima, Japan
| | - Yuji Fujikura
- National Defense Medical College Hospital, Department of Medical Risk Management and Infection Control, Tokorozawa, Japan
| | - Tsuyoshi Kitaura
- Tottori University Hospital, Division of Infectious Diseases, Yonago, Japan
| | - Mitsuhiro Sunakawa
- Tokyo Medical and Dental University, Dental Hospital, Infection Control Team, Tokyo, Japan
| | - Tetsuya Yagi
- Nagoya University Hospital, Department of Infectious Diseases, Nagoya, Japan
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Halani S, McIntyre M, Vaisman A. The Harms of Postoperative Antibiotic Prophylaxis: A Teachable Moment. JAMA Intern Med 2022; 182:545-546. [PMID: 35343997 DOI: 10.1001/jamainternmed.2022.0413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sheliza Halani
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark McIntyre
- Antimicrobial Stewardship Program, Sinai Health - University Health Network, Toronto, Ontario, Canada
| | - Alon Vaisman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, University Health Network, Toronto, Ontario, Canada
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Cefazolin Might Be Adequate for Perioperative Antibiotic Prophylaxis in Intra-Abdominal Infections without Sepsis: A Quality Improvement Study. Antibiotics (Basel) 2022; 11:antibiotics11040501. [PMID: 35453252 PMCID: PMC9025420 DOI: 10.3390/antibiotics11040501] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 12/18/2022] Open
Abstract
Background: The adequate choice of perioperative antibiotic prophylaxis (PAP) could influence the risk of surgical site infections (SSIs) in general surgery. A new local PAP guideline was implemented in May 2017 and set the first-generation cefazolin (CFZ) instead the second-generation cefuroxime (CXM) as the new standard prophylactic antibiotic. The aim of this study was to compare the risk of SSIs after this implementation in intra-abdominal infections (IAIs) without sepsis. Methods: We performed a single center-quality improvement study at a 1500 bed sized university hospital in Germany analyzing patients after emergency surgery during 2016 to 2019 (n = 985), of which patients receiving CXM or CFZ were selected (n = 587). Propensity score matching was performed to ensure a comparable risk of SSIs in both groups. None-inferiority margin for SSIs was defined as 8% vs. 4%. Results: Two matched cohorts with respectively 196 patients were compared. The rate of SSIs was higher in the CFZ group (7.1% vs. 3.6%, p = 0.117) below the non-inferiority margin. The rate of other postoperative infections was significantly higher in the CFZ group (2.0% vs. 8.7%, p = 0.004). No other differences including postoperative morbidity, mortality or length-of-stay were observed. Conclusion: Perioperative antibiotic prophylaxis might be safely maintained by CFZ even in the treatment of intra-abdominal infections.
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Phan QTN, Le TD, Do QK, Pham HTT, Tran MTP, Vo TD, Le LV, Nguyen TM, Tran NQ, Nguyen NTY, Nguyen HT, Bui QTH. Impact of antimicrobial stewardship intervention in clean and clean‐contaminated surgical procedures at a Vietnamese national hospital. Trop Med Int Health 2022; 27:454-462. [DOI: 10.1111/tmi.13738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
AbstractObjectivesWe investigated the characteristics of prophylactic antimicrobial use in clean and clean‐contaminated surgical procedures and assessed the efficacy of a prophylactic antimicrobial stewardship intervention at Thong Nhat Hospital, Ho Chi Minh City, Vietnam.MethodsA cross‐sectional study was conducted on 354 patients who underwent either clean or clean‐contaminated surgical procedures at Thong Nhat Hospital. Eligible patients were classified with respect to three periods of intervention from 2017 to 2020. Data collection included surgical procedures, patient characteristics, and prophylactic antimicrobial usage. We determined the efficacy of antimicrobial stewardship intervention based on comparisons among the primary outcome (the appropriateness of prophylactic antimicrobials) and secondary outcomes (postoperative antimicrobial prophylaxis (AP) prolongation, length of postoperative hospital stay, and cost of antimicrobials).ResultsThe mean age of patients in periods 1, 2, and 3 was 54.5 ± 16.6, 50.2 ± 16.5, and 52.8 ± 17.3 years, respectively, with an overall male/female ratio of 1.1/1. No significant differences were detected in basic patient characteristics during the three periods. Majority of the surgical procedures were clean (56%–59%) and scheduled (85%–86%). Prophylactic antimicrobial stewardship intervention enhanced AP appropriateness (by 12.7%, 12.7%, and 39.0% in periods 1, 2, and 3, respectively, p < 0.001), decreased postoperative prophylactic antimicrobial duration [3.0 (0–6), 1.5 (0–5), and 0.0 (0–1) days, respectively, p < 0.001], and reduced average antimicrobial expenses (p < 0.001).ConclusionsThe prophylactic antimicrobial stewardship interventions introduced at Thong Nhat Hospital had several positive impacts on the appropriateness of prophylactic antimicrobial use and treatment costs.
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Affiliation(s)
- Quyen Thi Ngoc Phan
- Department of Clinical Pharmacy Faculty of Pharmacy University of Medicine and Pharmacy at Ho Chi Minh City Ho Chi Minh City Vietnam
| | | | - Que Kim Do
- Thong Nhat Hospital Ho Chi Minh City Vietnam
| | | | | | - Thong Duy Vo
- Department of Internal Medicine Faculty of Medicine University of Medicine and Pharmacy at Ho Chi Minh City Ho Chi Minh City Vietnam
| | - Lam Van Le
- Thong Nhat Hospital Ho Chi Minh City Vietnam
| | | | | | | | | | - Quynh Thi Huong Bui
- Department of Clinical Pharmacy Faculty of Pharmacy University of Medicine and Pharmacy at Ho Chi Minh City Ho Chi Minh City Vietnam
- Thong Nhat Hospital Ho Chi Minh City Vietnam
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22
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Lu P, Holden D, Padiglione A, Cleland H. Perioperative antibiotic prophylaxis in Australian burns patients. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n1.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Perioperative antibiotic prophylaxis is perceived to reduce intraoperative bacteraemia and prevent surgical site infections, however, the evidence for its use in burns surgery is limited. Excessive use of perioperative antibiotics has become a growing concern. The authors aimed to audit the prescribing practices of perioperative antibiotic prophylaxis at the Victorian Adult Burns Service and determine whether the duration of antibiotic prophylaxis influenced the risk of postoperative wound infection, bacte-raemia and antibiotic resistance.
Methods: This retrospective chart review included all acute adult burns patients who had an operation between November 2018 and November 2019. Basic demographic data, burn specific data and data on perioperative antibiotic use were collected. The outcome measures were wound infection, bacteraemia, other infections and presence of resistant organisms.
Results: Results demonstrated that almost all patients (98.6%) received perioperative antibiotic prophylax-is. In comparison, there was no significant difference between the rate of postoperative wound infection, bacteraemia or antibiotic resistance between patients receiving a short or long course of antibiotics.
Conclusion: The results of our study demonstrate variable use of perioperative antibiotic prophylaxis with-in one burns unit. There were many cases of unsubstantiated use of long courses of antibiotics without apparent benefit for clinical outcomes of wound infection or bacteraemia. With the growing concern over antibiotic overuse and development of resistance, there is an increasing need for development of clear guidelines for antibiotic use in burns surgery.
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23
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Olsen MA, Greenberg JK, Peacock K, Nickel KB, Fraser VJ, Warren DK. Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion. J Antimicrob Chemother 2022; 77:1178-1184. [PMID: 35040936 PMCID: PMC9126069 DOI: 10.1093/jac/dkab475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/24/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To determine the prevalence and factors associated with post-discharge prophylactic antibiotic use after spinal fusion and whether use was associated with decreased risk of surgical site infection (SSI). METHODS Persons aged 10-64 years undergoing spinal fusion between 1 January 2010 and 30 June 2015 were identified in the MarketScan Commercial Database. Complicated patients and those coded for infection from 30 days before to 2 days after the surgical admission were excluded. Outpatient oral antibiotics were identified within 2 days of surgical discharge. SSI was defined using ICD-9-CM diagnosis codes within 90 days of surgery. Generalized linear models were used to determine factors associated with post-discharge prophylactic antibiotic use and with SSI. RESULTS The cohort included 156 446 fusion procedures, with post-discharge prophylactic antibiotics used in 9223 (5.9%) surgeries. SSIs occurred after 2557 (1.6%) procedures. Factors significantly associated with post-discharge prophylactic antibiotics included history of lymphoma, diabetes, 3-7 versus 1-2 vertebral levels fused, and non-infectious postoperative complications. In multivariable analysis, post-discharge prophylactic antibiotic use was not associated with SSI risk after spinal fusion (relative risk 0.98; 95% CI 0.84-1.14). CONCLUSIONS Post-discharge prophylactic oral antibiotics after spinal fusion were used more commonly in patients with major medical comorbidities, more complex surgeries and those with postoperative complications during the surgical admission. After adjusting for surgical complexity and infection risk factors, post-discharge prophylactic antibiotic use was not associated with decreased SSI risk. These results suggest that prolonged prophylactic antibiotic use should be avoided after spine surgery, given the lack of benefit and potential for harm.
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Affiliation(s)
- Margaret A. Olsen
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacob K. Greenberg
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Kate Peacock
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Katelin B. Nickel
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Victoria J. Fraser
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - David K. Warren
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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Applying Machine Learning Techniques to the Audit of Antimicrobial Prophylaxis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High rates of inappropriate use of surgical antimicrobial prophylaxis were reported in many countries. Auditing the prophylactic antimicrobial use in enormous medical records by manual review is labor-intensive and time-consuming. The purpose of this study is to develop accurate and efficient machine learning models for auditing appropriate surgical antimicrobial prophylaxis. The supervised machine learning classifiers (Auto-WEKA, multilayer perceptron, decision tree, SimpleLogistic, Bagging, and AdaBoost) were applied to an antimicrobial prophylaxis dataset, which contained 601 instances with 26 attributes. Multilayer perceptron, SimpleLogistic selected by Auto-WEKA, and decision tree algorithms had outstanding discrimination with weighted average AUC > 0.97. The Bagging and SMOTE algorithms could improve the predictive performance of decision tree against imbalanced datasets. Although with better performance measures, multilayer perceptron and Auto-WEKA took more execution time as compared with that of other algorithms. Multilayer perceptron, SimpleLogistic, and decision tree algorithms have outstanding performance measures for identifying the appropriateness of surgical prophylaxis. The efficient models developed by machine learning can be used to assist the antimicrobial stewardship team in the audit of surgical antimicrobial prophylaxis. In future research, we still have the challenges and opportunities of enriching our datasets with more useful clinical information to improve the performance of the algorithms.
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Hardefeldt LY, Hur B, Richards S, Scarborough R, Browning GF, Billman-Jacobe H, Gilkerson JR, Ierardo J, Awad M, Chay R, Bailey KE. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac015. [PMID: 35233530 PMCID: PMC8874133 DOI: 10.1093/jacamr/dlac015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background Antimicrobial stewardship programmes (ASPs) have been widely implemented in medical practice to improve antimicrobial prescribing and reduce selection for multidrug-resistant pathogens. Objectives To implement different antimicrobial stewardship intervention packages in 135 veterinary practices and assess their impact on antimicrobial prescribing. Methods In October 2018, general veterinary clinics were assigned to one of three levels of ASP, education only (CON), intermediate (AMS1) or intensive (AMS2). De-identified prescribing data (1 October 2016 to 31 October 2020), sourced from VetCompass Australia, were analysed and a Poisson regression model fitted to identify the effect of the interventions on the incidence rates of antimicrobial prescribing. Results The overall incidence rate (IR) of antimicrobial prescribing for dogs and cats prior to the intervention was 3.7/100 consultations, which declined by 36% (2.4/100) in the implementation period, and by 50% (1.9/100) during the post-implementation period. Compared with CON, in AMS2 there was a 4% and 6% reduction in the overall IR of antimicrobial prescribing, and a 24% and 24% reduction in IR of high importance antimicrobial prescribing, attributable to the intervention in the implementation and post-implementation periods, respectively. A greater mean difference in the IR of antimicrobial prescribing was seen in high-prescribing clinics. Conclusions These AMS interventions had a positive impact in a large group of general veterinary practices, resulting in a decline in overall antimicrobial use and a shift towards use of antimicrobials rated as low importance, with the greatest impact in high-prescribing clinics.
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Affiliation(s)
- L. Y. Hardefeldt
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
- Corresponding author. E-mail:
| | - B. Hur
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - S. Richards
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
| | - R. Scarborough
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
| | - G. F. Browning
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
| | - H. Billman-Jacobe
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
| | - J. R. Gilkerson
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
| | - J. Ierardo
- Greencross Vets Pty Ltd, Brisbane, Queensland, Australia
| | - M. Awad
- Greencross Vets Pty Ltd, Brisbane, Queensland, Australia
| | - R. Chay
- Greencross Vets Pty Ltd, Brisbane, Queensland, Australia
| | - K. E. Bailey
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
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Aldrees A, Ghonem L, Almajid F, Barry M, Mayet A, Almohaya AM. Evaluating the Inappropriate Prescribing and Utilization of Caspofungin, a Four-Year Analysis at a Teaching Hospital in Saudi Arabia. Antibiotics (Basel) 2021; 10:antibiotics10121498. [PMID: 34943710 PMCID: PMC8698732 DOI: 10.3390/antibiotics10121498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 11/16/2022] Open
Abstract
The appropriate use of antimicrobial agents improves clinical outcomes and reduces antimicrobial resistance. Nevertheless, data on inappropriate prescription and negative outcomes are inconsistent. The objective of this study was to assess the prescription appropriateness of Caspofungin at a tertiary teaching hospital in Saudi Arabia and the impact on mortality at 30 days. A retrospective chart review was performed for patients who received Caspofungin from May 2015 to December 2019 to obtain prescription information and culture and susceptibility tests. The appropriateness of the dosage (ApD), initiation time (ApI), agent selection (ApS), and duration of therapy (ApDUR) was evaluated based on recommendations of the infectious diseases society of America. 355 eligible patients who received 3458 Caspofungin doses were identified. Their median age was 54 years (range 18-96). Overall, 270 (76.1%) patients received empirical prescriptions, of which 74.4% had the appropriate dose, and 56.3% had received it for more than five days, despite no proven Candida infection. This was not influenced by past medical history (p = 0.394). Only 39% of patients who received definitive prescriptions met all four study criteria for appropriate prescription. Therefore, antimicrobial stewardship programs can improve the appropriate utilization of antifungal therapies.
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Affiliation(s)
- Abdulwahab Aldrees
- Infectious Disease Unit, College of Medicine and King Saud University Medical City, King Saud University, Riyadh 12372, Saudi Arabia; (A.A.); (F.A.); (M.B.)
- Department of Medicine, Al-Diriyah General Hospital, Ar-Rihab, Ad Diriyah 13717, Saudi Arabia
| | - Leen Ghonem
- Department of Pharmacy, King Saudi University Medical City, Riyadh 11451, Saudi Arabia; (L.G.); (A.M.)
| | - Fahad Almajid
- Infectious Disease Unit, College of Medicine and King Saud University Medical City, King Saud University, Riyadh 12372, Saudi Arabia; (A.A.); (F.A.); (M.B.)
| | - Mazin Barry
- Infectious Disease Unit, College of Medicine and King Saud University Medical City, King Saud University, Riyadh 12372, Saudi Arabia; (A.A.); (F.A.); (M.B.)
| | - Ahmed Mayet
- Department of Pharmacy, King Saudi University Medical City, Riyadh 11451, Saudi Arabia; (L.G.); (A.M.)
| | - Abdulellah M. Almohaya
- Infectious Disease Unit, College of Medicine and King Saud University Medical City, King Saud University, Riyadh 12372, Saudi Arabia; (A.A.); (F.A.); (M.B.)
- Department of Medicine, Al-Diriyah General Hospital, Ar-Rihab, Ad Diriyah 13717, Saudi Arabia
- Correspondence: ; Tel.: +966-11-835-6500
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Thursky KA, Hardefeldt LY, Rajkhowa A, Ierano C, Bishop J, Hawes L, Biezen R, Saha SK, Dowson L, Bailey KE, Scarborough R, Little SB, Gotterson F, Hur B, Khanina A, Urbancic K, Crabb HK, Richards S, Sri A, James R, Kong DCM, Marshall C, Mazza D, Peel T, Stuart RL, Manski-Nankervis JA, Friedman ND, Bennett N, Schulz T, Billman-Jacobe H, Buono E, Worth L, Bull A, Richards M, Ayton D, Gilkerson JR, Browning GF, Buising KL. Antimicrobial stewardship in Australia: the role of qualitative research in programme development. JAC Antimicrob Resist 2021; 3:dlab166. [PMID: 34806005 PMCID: PMC8600289 DOI: 10.1093/jacamr/dlab166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Antimicrobial stewardship (AMS) in Australia is supported by a number of factors, including enabling national policies, sectoral clinical governance frameworks and surveillance programmes, clinician-led educational initiatives and health services research. A One Health research programme undertaken by the National Centre for Antimicrobial Stewardship (NCAS) in Australia has combined antimicrobial prescribing surveillance with qualitative research focused on developing antimicrobial use-related situational analyses and scoping AMS implementation options across healthcare settings, including metropolitan hospitals, regional and rural hospitals, aged care homes, general practice clinics and companion animal and agricultural veterinary practices. Qualitative research involving clinicians across these diverse settings in Australia has contributed to improved understanding of contextual factors that influence antimicrobial prescribing, and barriers and facilitators of AMS implementation. This body of research has been underpinned by a commitment to supplementing 'big data' on antimicrobial prescribing practices, where available, with knowledge of the sociocultural, technical, environmental and other factors that shape prescribing behaviours. NCAS provided a unique opportunity for exchange and cross-pollination across the human and animal health programme domains. It has facilitated synergistic approaches to AMS research and education, and implementation of resources and stewardship activities. The NCAS programme aimed to synergistically combine quantitative and qualitative approaches to AMS research. In this article, we describe the qualitative findings of the first 5 years.
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Affiliation(s)
- Karin A Thursky
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia
- Guidance Group, Royal Melbourne Hospital, Melbourne Health, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne and Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Laura Y Hardefeldt
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Corner Park Drive and Flemington Road, Building 400, Parkville, Victoria 3010, Australia
| | - Arjun Rajkhowa
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
| | - Courtney Ierano
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
| | - Jaclyn Bishop
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Pharmacy Department, Ballarat Health Services, 1 Drummond Street North, Ballarat, Victoria 3353, Australia
| | - Lesley Hawes
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of General Practice, Monash University, 1/270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia
| | - Ruby Biezen
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of General Practice, Monash University, 1/270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia
- Department of General Practice, University of Melbourne, 780 Elizabeth Street, Melbourne, Victoria 3010, Australia
| | - Sajal K Saha
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of General Practice, Monash University, 1/270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia
| | - Leslie Dowson
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - Kirsten E Bailey
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Corner Park Drive and Flemington Road, Building 400, Parkville, Victoria 3010, Australia
| | - Ri Scarborough
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Corner Park Drive and Flemington Road, Building 400, Parkville, Victoria 3010, Australia
| | - Stephen B Little
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Corner Park Drive and Flemington Road, Building 400, Parkville, Victoria 3010, Australia
| | - Fiona Gotterson
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
| | - Brian Hur
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Corner Park Drive and Flemington Road, Building 400, Parkville, Victoria 3010, Australia
| | - Anna Khanina
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne and Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Karen Urbancic
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
| | - Helen K Crabb
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Corner Park Drive and Flemington Road, Building 400, Parkville, Victoria 3010, Australia
| | - Suzanna Richards
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Corner Park Drive and Flemington Road, Building 400, Parkville, Victoria 3010, Australia
| | - Anna Sri
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Corner Park Drive and Flemington Road, Building 400, Parkville, Victoria 3010, Australia
| | - Rodney James
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Guidance Group, Royal Melbourne Hospital, Melbourne Health, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
| | - David C M Kong
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Pharmacy Department, Ballarat Health Services, 1 Drummond Street North, Ballarat, Victoria 3353, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - Caroline Marshall
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia
| | - Danielle Mazza
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of General Practice, Monash University, 1/270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia
| | - Trisha Peel
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, The Alfred and Central Clinical School, Burnet Institute, Monash University and Alfred Health, 85 Commercial Road, Monash University, Melbourne, Victoria 3004, Australia
| | - Rhonda L Stuart
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Departments of Infectious Diseases and Infection Control and Epidemiology, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Jo-Anne Manski-Nankervis
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of General Practice, University of Melbourne, 780 Elizabeth Street, Melbourne, Victoria 3010, Australia
| | - N Deborah Friedman
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, University Hospital Geelong, Barwon Health, Bellerine Street, Geelong, Victoria 3220, Australia
| | - Noleen Bennett
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Guidance Group, Royal Melbourne Hospital, Melbourne Health, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- VICNISS Coordinating Centre, Melbourne Health, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
| | - Thomas Schulz
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia
| | - Helen Billman-Jacobe
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Corner Park Drive and Flemington Road, Building 400, Parkville, Victoria 3010, Australia
| | - Evette Buono
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- New South Wales Clinical Excellence Commission, 1 Reserve Road, St Leonards, New South Wales 2065, Australia
| | - Leon Worth
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne and Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Ann Bull
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- VICNISS Coordinating Centre, Melbourne Health, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
| | - Michael Richards
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia
- VICNISS Coordinating Centre, Melbourne Health, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
| | - Darshini Ayton
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - James R Gilkerson
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Corner Park Drive and Flemington Road, Building 400, Parkville, Victoria 3010, Australia
| | - Glenn F Browning
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Corner Park Drive and Flemington Road, Building 400, Parkville, Victoria 3010, Australia
| | - Kirsty L Buising
- NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia
- Guidance Group, Royal Melbourne Hospital, Melbourne Health, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Peter Doherty Institute of Infection and Immunity, 792 Elizabeth Street, Melbourne Victoria, 3000, Australia
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Hassan S, Chan V, Stevens J, Stupans I, Gentle J. Surgical antimicrobial prophylaxis in open reduction internal fixation procedures at a metropolitan hospital in Australia: a retrospective audit. BMC Surg 2021; 21:404. [PMID: 34814898 PMCID: PMC8609780 DOI: 10.1186/s12893-021-01398-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background Open reduction internal fixation (ORIF) of closed fractures is a required indication for surgical antimicrobial prophylaxis (SAP). Guidelines contain recommendations on how best to prescribe SAP, however, adherence to SAP guidelines remains suboptimal. The Australian Therapeutic Guidelines: Antibiotic v16 (updated April 2019) advocates for single dose prophylaxis for ORIF procedures. There is a paucity of information on how SAP is prescribed for ORIF of closed fractures in Australian hospitals. The aim of this study was to identify prescribing practice and to evaluate guideline adherence pre- and post-guideline update. Methods A retrospective audit was conducted for patients undergoing an ORIF of closed fractures at a metropolitan teaching hospital in a 6-month period during 2018 (pre-guideline update) and 2019 (post-guideline update). Data were collected on prescribing practice (perioperative antibiotics prescribed, dose, time and route of administration and duration of prophylaxis) and compared to SAP recommendations in Therapeutic Guidelines: Antibiotic v15 (2018) and v16 (2019). Descriptive statistics and Chi square tests were used to report categorical variables. Binary logistic regression was used to identify factors associated with guideline adherence. A p-value < 0.05 was deemed statistically significant. Results Data were collected for a total of 390 patients (n = 185, 2018; n = 205, 2019). Cefazolin was the most commonly prescribed antibiotic as per guideline recommendations, with variable, yet appropriate doses observed across the two audit periods. While 78.3% of patients received SAP for the correct duration in 2018, only 20.4% of patients received single dose prophylaxis in 2019. Overall adherence to guidelines was 63.2% in the 2018, and 18.0% in the 2019 audit periods respectively. Patient age was significantly associated with an increase in overall guideline adherence, while lower limb fractures, an American Society of Anesthesiologists (ASA) score of 3 and emergency admissions were associated with decreased overall adherence to SAP guidelines. Conclusion Adherence to guidelines was greater with v15 (2018) compared with v16 (2019). Patient factors, including limb fracture site and ASA score, had little impact on guideline adherence. Further research is required to understand what influences guideline adherence in the orthopaedic setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01398-7.
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Affiliation(s)
- Sarah Hassan
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia. .,Department of Orthopaedics, Northern Health, Epping, VIC, Australia.
| | - Vincent Chan
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Julie Stevens
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.,Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Ieva Stupans
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Juliette Gentle
- Department of Orthopaedics, Northern Health, Epping, VIC, Australia
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29
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Surat G, Bernsen D, Schimmer C. Antimicrobial stewardship measures in cardiac surgery and its impact on surgical site infections. J Cardiothorac Surg 2021; 16:309. [PMID: 34670594 PMCID: PMC8527641 DOI: 10.1186/s13019-021-01693-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 10/11/2021] [Indexed: 12/24/2022] Open
Abstract
Objective The goal of this study was to monitor the compliance and impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery favouring cefazolin instead cefuroxime, initiated by the hospital’s antimicrobial stewardship team. Methods This quality improvement study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the hospitals antimicrobial stewardship team following a revision of the standard for surgical antimicrobial prophylaxis including 1029 patients who underwent cardiac surgery. 582 patients receiving cefuroxime and 447 patients receiving cefazolin respectively were compared without altering any other preventative perioperative measures including its postoperative duration of less than 24 h. Adherence and surgical site infections were compiled and analysed. Results A complete adherence was achieved. Overall surgical site infections occurred in 37 (3.6%) of the cases, 20 (3.4%) in cefuroxime patients and 17 (3.8%) in cefazolin patients (p value = 0.754). No statistically significant differences could be found in any of the primary endpoints, but there was a trend towards less deep sternal wound infections in the cefazolin group. Conclusions The study supports the role of antimicrobial stewardship in cardiac surgery and mirrors the success of a multidisciplinary team aiming to minimize adverse events by optimizing antibiotic use. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01693-7.
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Affiliation(s)
- Güzin Surat
- Unit for Infection Control and Antimicrobial Stewardship, University Hospital of Würzburg, Würzburg, Germany.
| | | | - Christoph Schimmer
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital of Würzburg, Würzburg, Germany
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30
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Gillani SW, Vippadapu P, Gulam SM. Physician-reported barriers and challenges to antibiotic prescribing in surgical prophylaxis: a structured systematic review. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Abstract
Objectives
The purpose of the study is to identify and analyse the barriers in surgical procedures where antibiotic dissipation is habitual.
Methods
Extensive literature search is carried out using different electronic databases (PubMed, Europe PMC, PLoS and Google Scholar) between January 2000 and December 2020. The articles were selected purely based on the inclusion criteria. Only qualitative and cross-sectional studies were selected to reduce the risk of bias. The JBI and AXIS checklists were used to assessed the quality of the enrolled articles. Data extractions were done by using a predesigned standardized data collection form.
Key findings
A total of 2067 articles were electronically retrieved but only 14 articles met the eligibility criteria. About 15 902 healthcare professionals (HCPs) with an average response rate of 64.7% were pooled for evidence synthesis. The majority of respondents (50%) discussed different barriers in their practice site for surgical antibiotic prophylaxis (SAP) administration. Barriers were categorized into four themes: lack of guideline availability and knowledge, lack of adherence to guidelines, lack of guideline knowledge and adherence and physician perceptions or off-label practices. A total of 723 (56.3%) out of 1282 HCPs from nine different studies reported a lack of adherence to guidelines during the perioperative process. The majority of respondents in three studies, 318 (82%) out of 386 HCPs, reported that physicians’ perceptions play a crucial role in prescribing SAP during surgeries.
Conclusion
This study concluded that the barriers within the practice site play a decisive role in SAP optimization and therefore all HCPs are recommended to maintain local/standard guidelines and adhere to them while prescribing SAP.
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Affiliation(s)
- Syed Wasif Gillani
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Prasanna Vippadapu
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
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31
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Brocard E, Reveiz L, Régnaux JP, Abdala V, Ramón-Pardo P, Del Rio Bueno A. Antibiotic prophylaxis for surgical procedures: a scoping review. Rev Panam Salud Publica 2021; 45:e62. [PMID: 34054932 PMCID: PMC8147733 DOI: 10.26633/rpsp.2021.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/12/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives To map the current evidence on surgical antibiotic prophylaxis (SAP) administration and identify knowledge gaps in the literature available in this field. Methods The PubMed, Cochrane Library, Epistemonikos, and Health Systems Evidence databases were searched from January 2015 to March 2020 for systematic reviews published in English, French, Portuguese, and Spanish. Results Eighty-three systematic reviews were included, the quality of the reviews was assessed using AMSTAR 2, and data were extracted for all primary outcomes. Perioperative antibiotic administration, the use of first generation cephalosporins, and surgical site infection (SSI) were the most commonly reported for timing of antibiotic administration, drug class, and primary outcome, respectively. Findings showed that, overall, SAP may reduce SSIs compared with a placebo or with no SAP. Results suggested that intraoperative SAP may lower SSI, while postoperative SAP did not show a statistically significant difference. Conclusions Findings have confirmed the role of SAP in reducing postoperative SSI across various surgeries and do not support the use of antibiotics after surgery to prevent infections. The findings of this scoping review have enhanced the evidence base that can inform decisions regarding the development of global guidelines for the prevention of SSI. However, high-quality systematic reviews and research reflecting diverse populations and settings are needed.
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Affiliation(s)
- Eva Brocard
- Ecole des Hautes Etudes en Santé Publique (EHESP) Rennes France Ecole des Hautes Etudes en Santé Publique (EHESP), Rennes, France.,Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Ludovic Reveiz
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Jean-Philippe Régnaux
- Ecole des Hautes Etudes en Santé Publique (EHESP) Rennes France Ecole des Hautes Etudes en Santé Publique (EHESP), Rennes, France
| | - Veronica Abdala
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Pilar Ramón-Pardo
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Ana Del Rio Bueno
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
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32
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Quality of inpatient antimicrobial use in hematology and oncology patients. Infect Control Hosp Epidemiol 2021; 42:1235-1244. [PMID: 33517920 DOI: 10.1017/ice.2020.1398] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To compare antimicrobial prescribing practices in Australian hematology and oncology patients to noncancer acute inpatients and to identify targets for stewardship interventions. DESIGN Retrospective comparative analysis of a national prospectively collected database. METHODS Using data from the 2014-2018 annual Australian point-prevalence surveys of antimicrobial prescribing in hospitalized patients (ie, Hospital National Antimicrobial Prescribing Survey called Hospital NAPS), the most frequently used antimicrobials, their appropriateness, and guideline concordance were compared among hematology/bone marrow transplant (hemBMT), oncology, and noncancer inpatients in the setting of treatment of neutropenic fever and antibacterial and antifungal prophylaxis. RESULTS In 454 facilities, 94,226 antibiotic prescriptions for 62,607 adult inpatients (2,230 hemBMT, 1,824 oncology, and 58,553 noncancer) were analyzed. Appropriateness was high for neutropenic fever management across groups (83.4%-90.4%); however, hemBMT patients had high rates of carbapenem use (111 of 746 prescriptions, 14.9%), and 20.2% of these prescriptions were deemed inappropriate. Logistic regression demonstrated that hemBMT patients were more likely to receive appropriate antifungal prophylaxis compared to oncology and noncancer patients (adjusted OR, 5.3; P < .001 for hemBMT compared to noncancer patients). Oncology had a low rate of antifungal prophylaxis guideline compliance (67.2%), and incorrect dosage and frequency were key factors. Compared to oncology patients, hemBMT patients were more likely to receive appropriate nonsurgical antibacterial prophylaxis (aOR, 8.4; 95% CI, 5.3-13.3; P < .001). HemBMT patients were also more likely to receive appropriate nonsurgical antibacterial prophylaxis compared to noncancer patients (OR, 3.1; 95% CI, 1.9-5.0; P < .001). However, in the Australian context, the hemBMT group had higher than expected use of fluoroquinolone prophylaxis (66 of 831 prescriptions, 8%). CONCLUSIONS This study demonstrates why separate analysis of hemBMT and oncology populations is necessary to identify specific opportunities for quality improvement in each patient group.
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Della Polla G, Bianco A, Mazzea S, Napolitano F, Angelillo IF. Preoperative Antibiotic Prophylaxis in Elective Minor Surgical Procedures among Adults in Southern Italy. Antibiotics (Basel) 2020; 9:antibiotics9100713. [PMID: 33081002 PMCID: PMC7603198 DOI: 10.3390/antibiotics9100713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022] Open
Abstract
Little is known regarding the factors associated with surgical antibiotic prophylaxis (SAP) compliance in elective minor surgery. The purposes of this cross-sectional study were to identify the frequency of inappropriate SAP administration and to understand the characteristics associated with such inappropriateness in a sample of elective minor surgical procedures. The study was performed between May and July 2019 among a random sample of patients aged 18 years and older in seven public hospitals randomly selected in the Campania and Calabria Regions of Italy. Globally, only 45% of SAP approaches were deemed completely in accordance with the evidence-based guidelines. Patients with an ordinary admission, those who underwent local anesthesia, those receiving plastic and reconstructive and ophthalmology surgery, and those who had not received a prosthetic implant were more likely to receive an appropriate SAP approach; those receiving obstetrics, gynecological, and urological surgical procedures were less likely than those who underwent abdominal, vascular, and breast surgery. The course of antibiotic prophylaxis was not consistent with the guidelines in 48.5% procedures with one or more reasons for inappropriateness. Appropriate time of the SAP administration was more frequently observed in patients who were older, those with a Charlson comorbidity index of 0, those who did not receive a prosthetic implant, and those receiving plastic and reconstructive surgery; it was less likely in patients receiving obstetrics, gynecological, and urological surgeries compared with those who underwent abdominal, vascular, and breast surgery. Aspects of SAP that need to be improved are molecule choice, time of administration, and specific surgical procedures. Hospital managers should involve surgeons and anesthesiologists in initiatives tailored to optimize SAP prescribing.
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Affiliation(s)
- Giorgia Della Polla
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, 5 80138 Naples, Italy; (G.D.P.); (F.N.)
| | - Aida Bianco
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Via Tommaso Campanella, 115 88100 Catanzaro, Italy; (A.B.); (S.M.)
| | - Silvia Mazzea
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Via Tommaso Campanella, 115 88100 Catanzaro, Italy; (A.B.); (S.M.)
| | - Francesco Napolitano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, 5 80138 Naples, Italy; (G.D.P.); (F.N.)
| | - Italo Francesco Angelillo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, 5 80138 Naples, Italy; (G.D.P.); (F.N.)
- Correspondence: ; Tel.: +39-081-566-7717
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Browne K, Chakraborty S, Chen R, Willcox MDP, Black DS, Walsh WR, Kumar N. A New Era of Antibiotics: The Clinical Potential of Antimicrobial Peptides. Int J Mol Sci 2020; 21:E7047. [PMID: 32987946 PMCID: PMC7582481 DOI: 10.3390/ijms21197047] [Citation(s) in RCA: 207] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022] Open
Abstract
Antimicrobial resistance is a multifaceted crisis, imposing a serious threat to global health. The traditional antibiotic pipeline has been exhausted, prompting research into alternate antimicrobial strategies. Inspired by nature, antimicrobial peptides are rapidly gaining attention for their clinical potential as they present distinct advantages over traditional antibiotics. Antimicrobial peptides are found in all forms of life and demonstrate a pivotal role in the innate immune system. Many antimicrobial peptides are evolutionarily conserved, with limited propensity for resistance. Additionally, chemical modifications to the peptide backbone can be used to improve biological activity and stability and reduce toxicity. This review details the therapeutic potential of peptide-based antimicrobials, as well as the challenges needed to overcome in order for clinical translation. We explore the proposed mechanisms of activity, design of synthetic biomimics, and how this novel class of antimicrobial compound may address the need for effective antibiotics. Finally, we discuss commercially available peptide-based antimicrobials and antimicrobial peptides in clinical trials.
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Affiliation(s)
- Katrina Browne
- School of Chemistry, University of New South Wales (UNSW) Sydney, Sydney 2052, Australia; (K.B.); (S.C.); (R.C.)
| | - Sudip Chakraborty
- School of Chemistry, University of New South Wales (UNSW) Sydney, Sydney 2052, Australia; (K.B.); (S.C.); (R.C.)
| | - Renxun Chen
- School of Chemistry, University of New South Wales (UNSW) Sydney, Sydney 2052, Australia; (K.B.); (S.C.); (R.C.)
| | - Mark DP Willcox
- School of Optometry and Vision Science, University of New South Wales (UNSW) Sydney, Sydney 2052, Australia;
| | - David StClair Black
- School of Chemistry, University of New South Wales (UNSW) Sydney, Sydney 2052, Australia; (K.B.); (S.C.); (R.C.)
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Prince of Wales Hospital, University of New South Wales (UNSW), Randwick 2031, Australia;
| | - Naresh Kumar
- School of Chemistry, University of New South Wales (UNSW) Sydney, Sydney 2052, Australia; (K.B.); (S.C.); (R.C.)
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Identifying targets for improvement using a nationally standardized survey: Surgical antimicrobial prophylaxis in orthopedic surgery. Infect Control Hosp Epidemiol 2020; 41:1419-1428. [PMID: 32838821 DOI: 10.1017/ice.2020.320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Surgical antimicrobial prophylaxis (SAP) is commonly administered in orthopedic procedures. Research regarding SAP appropriateness for specific orthopedic procedures is limited and is required to facilitate targeted orthopedic prescriber behavior change. OBJECTIVES To describe SAP prescribing and appropriateness for orthopedic procedures in Australian hospitals. DESIGN, SETTING, AND PARTICIPANTS Multicenter, national, quality improvement study with retrospective analysis of data collected from Australian hospitals via Surgical National Antimicrobial Prescribing Survey (Surgical NAPS) audits from January 1, 2016, to April 15, 2019, were analyzed. METHODS Logistic regression identified hospital, patient and surgical factors associated with appropriateness. Adjusted appropriateness was calculated from the multivariable model. Additional subanalyses were conducted on smaller subsets to calculate the adjusted appropriateness for specific orthopedic procedures. RESULTS In total, 140 facilities contributed to orthopedic audits in the Surgical NAPS, including 4,032 orthopedic surgical episodes and 6,709 prescribed doses. Overall appropriateness was low, 58.0% (n = 3,894). This differed for prescribed procedural (n = 3,978, 64.7%) and postprocedural doses (n = 2,731, 48.3%). The most common reasons for inappropriateness, when prophylaxis was required, was timing for procedural doses (50.9%) and duration for postprocedural prescriptions (49.8%). The adjusted appropriateness of each orthopedic procedure group was low for procedural SAP (knee surgery, 54.1% to total knee joint replacement, 74.1%). The adjusted appropriateness for postprocedural prescription was also low (from hand surgery, 40.7%, to closed reduction fractures, 68.7%). CONCLUSIONS Orthopedic surgical specialties demonstrated differences across procedural and postprocedural appropriateness. The metric of appropriateness identifies targets for quality improvement and is meaningful for clinicians. Targeted quality improvement projects for orthopedic specialties need to be developed to support optimization of antimicrobial use.
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36
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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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37
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Ierano C, Rajkhowa A, Peel T, Marshall C, Ayton D, Thursky K. Antibiotic prescribing in surgery: A clinically and socially complex problem in Australia. Infect Dis Health 2020; 25:309-313. [PMID: 32444345 DOI: 10.1016/j.idh.2020.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/11/2020] [Accepted: 04/12/2020] [Indexed: 11/15/2022]
Abstract
Surgical prophylaxis is a common indication for antimicrobial use in Australian hospitals with demonstrated poor rates of appropriateness. Ongoing analysis of the Surgical National Antimicrobial Prescribing Survey and exploration of influences on antimicrobial prescribing decisions can help identify clinical and behavioural issues that contribute to problematic antimicrobial use. Triangulation of quantitative and qualitiatve data supports the development of surgical antimicrobial stewardship, i.e., quality improvement initiatives for the optimisation of surgical antimicrobial prophylaxis. Such initiatives should be developed and implemented at both local and national levels to ensure that they remain effective and sustainable.
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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.
| | - Arjun Rajkhowa
- 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
| | - 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
| | - Darshini Ayton
- Monash University, Department of Epidemiology and Preventive Medicine, 553 St Kilda Road, Melbourne, 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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38
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Pulcini C, Hulscher M. How Can We Routinely Measure Appropriateness of Antimicrobial Use in Hospitals at a National Level? JAMA Netw Open 2019; 2:e1915030. [PMID: 31702794 DOI: 10.1001/jamanetworkopen.2019.15030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Céline Pulcini
- APEMAC, Université de Lorraine, Nancy, France
- Infectious Diseases Department, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Marlies Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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