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Sherkat Masoum M, Oorschot S, Roles B, Italiano C. Barriers to Optimal Surgical Antimicrobial Prophylaxis for Methicillin-Resistant Staphylococcus aureus-Colonized Patients at an Australian Tertiary Teaching Hospital. Surg Infect (Larchmt) 2023; 24:158-162. [PMID: 36594989 DOI: 10.1089/sur.2022.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Surgical antimicrobial prophylaxis (SAP) is a leading indication for antibiotic use in Australian hospitals with established high rates of inappropriate prescribing. Optimal administration of SAP for patients at high risk of methicillin-resistant Staphylococcus aureus (MRSA) infections presents additional complexities. A greater understanding of barriers to optimal SAP in this cohort is required to inform targeted antimicrobial stewardship strategies, optimize SAP, and reduce the rate of surgical site infections (SSIs). Methods: A multiple-choice questionnaire appraising knowledge and barriers to optimal SAP was electronically distributed to key stakeholders. Data from the questionnaire were collated and analyzed using Survey Monkey® (Momentive Inc., San Mateo, CA) data analysis tools. Results: Eighty-three persons provided full or partial responses to the questionnaire. There were 19% of respondents who considered MRSA colonization status of patients to be only "somewhat important" when selecting appropriate SAP. Additionally, 62% of responses did not correctly identify the appropriate SAP regimen for patients who are colonized with MRSA. Several barriers to optimal SAP were identified including poor understanding of SAP guidelines, lack of timely identification of patients confirmed to be colonized with MRSA, inaccurate documentation of antibiotic and surgical start times, and limitations of the current operating room management software program. Conclusions: The high level of engagement from most key stakeholders demonstrates accountability and an overall desire to improve SAP. Barriers identified in this audit should be considered by facilities wishing to optimize compliance with SAP guidelines and consequently reduce SSIs, in particular for patients who are at high risk of MRSA infections.
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Affiliation(s)
- Maryam Sherkat Masoum
- Department of Pharmacy, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sarah Oorschot
- Department of Pharmacy, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Brittany Roles
- Department of Pharmacy, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Claire Italiano
- Department of Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
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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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Nguyen HT, Bui QTH, Vo TV, Pham HTT, Vo TD. Antibiotic use in gastrointestinal surgery patients at a Vietnamese national hospital. BMC Gastroenterol 2022; 22:480. [PMID: 36418962 PMCID: PMC9682786 DOI: 10.1186/s12876-022-02587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 11/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Invasive gastrointestinal surgery may be performed as an open or endoscopic procedure, such as laparoscopic semi-colon surgery, laparoscopic appendectomy, laparoscopic gastrectomy, and anal surgery, among other such operations. Regardless of the approach, the operative procedure interferes with the patient's gastrointestinal tract, necessitating the rational use of prophylactic antibiotics to improve treatment outcomes and minimize postoperative infections. OBJECTIVE To investigate the prophylactic and postoperative antibiotic usage in patients who underwent invasive gastrointestinal surgery, and to identify factors associated with postoperative infection. DESIGN This descriptive, cross-sectional study included 112 patients who underwent invasive gastrointestinal surgery at the Department of Gastroenterology, Thong Nhat Hospital. We conducted a cross-sectional study in all inpatients aged 18 years and older, who underwent invasive gastrointestinal surgery between January 2020 and December 2020. We recorded patient characteristics, the administration and appropriateness of antibiotics, as well as treatment outcomes. The appropriateness of prophylactic and postoperative antibiotic usage was assessed based on 2015 Vietnamese national guideline for antibiotic use. Multivariable logistic regression analysis was used to determine the factors associated with postoperative infection. RESULTS Patients' mean age was 59.7 ± 17.2 years. Most surgeries (89.3%) were clean-contaminated procedures. The rates of appropriate types of antibiotics selected, doses, and overall rates of appropriateness of antibiotic prophylaxis were 68.0%, 76.4% and 54.7%, respectively. Of the patients investigated, 34.8% had at least one sign of postoperative infection; the overall appropriate rate of postoperative antibiotic was 38.5%. Old age was associated with postoperative infection and longer length of hospitalization. CONCLUSION Implementation of the guidelines recommended for the prophylactic and therapeutic use of antibiotics is essential to improve treatment outcomes.
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Affiliation(s)
- Huyen Thi Nguyen
- grid.413054.70000 0004 0468 9247Department of Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Quynh Thi Huong Bui
- grid.413054.70000 0004 0468 9247Department of Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam ,Department of Pharmacy, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Tam Van Vo
- grid.413054.70000 0004 0468 9247Faculty of Nursing and Medical Technology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hien Thi Thu Pham
- Department of Pharmacy, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Thong Duy Vo
- grid.413054.70000 0004 0468 9247Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at City, 217 Hong Bang, Ward 11, Dis. 5, Ho Chi Minh City, 72714 Vietnam ,grid.414275.10000 0004 0620 1102Department of Gastroenterology and Hepatology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
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Assessment of implementation of antibiotic stewardship program in surgical prophylaxis at a secondary care hospital in Ras Al Khaimah, United Arab Emirates. Sci Rep 2021; 11:1042. [PMID: 33441843 PMCID: PMC7806636 DOI: 10.1038/s41598-020-80219-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023] Open
Abstract
Antibiotic overuse is a major factor for causing antibiotic resistance globally. However, only few studies reported the implementation and evaluation of antimicrobial stewardship programs in Gulf Cooperation Council. This study was conducted within 8-months periods to evaluate the effect of the newly implemented antibiotic stewardship program on improving the prescribing practice of surgical antibiotic prophylaxis in a secondary care hospital in the United Arab Emirates by releasing local hospital guidelines. The data of 493 in patients were documented in the predesigned patient profile form and the prescribing practice of surgical antibiotic prophylaxis for clean and clean-contaminant surgical procedures was compared and analyzed two months’ prior (period A) and post (period B) the implementation of antibiotic stewardship program. The 347 patient’s data (PD) were analyzed during period A and 146 PD during period B. The prescription of piperacillin/tazobactam was decreased from 2.4% from all surgical prophylaxis antibiotic orders in period A to 0% in period B. The appropriateness of the antibiotic therapy was found to differ non significantly for the selection of prophylactic antibiotic (p = 0.552) and for the timing of first dose administration (p = 0.061) between A and B periods. The total compliance was decreased non significantly (P = 0.08) from 45.3 to 40.2%. Overall, the guidelines have improved the prescribing practice of antibiotics prior to surgery. However, further improvement can be achieved by initiating educational intervention via cyclic auditing strategy.
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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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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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Surgical antimicrobial prophylaxis prescribing practices and impact on infection risk: Results from a multicenter surveillance study in Italy (2012-2017). Am J Infect Control 2019; 47:1426-1430. [PMID: 31400885 DOI: 10.1016/j.ajic.2019.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Italy is one of the largest consumers of broad-spectrum agents (BSAs) in Europe. This study evaluated surgical antimicrobial prophylaxis (SAP) compliance with the Italian national guidelines and its impact on surgical site infection (SSI) risk. METHODS A prospective study was conducted in 42 hospitals participating in the national surveillance system for SSIs. SAP compliance was evaluated considering antibiotic choice, duration of administration, and timing of first dose. Trends in the consumption of 5 BSAs were also evaluated. RESULTS Between 2012 and 2017, 24,861 surgical procedures were monitored. The risk ratios (RRs) for appropriate SAP increased by 22% each year, and significant increasing trends over time were found for overall compliance, timing, and duration. Adequate antibiotic choice and duration of administration were associated with a significantly reduced SSI risk (RR = 0.57; 95% confidence interval [CI], 0.5-0.65 vs RR = 0.51; 95% CI, 0.45-0.57, respectively), and overall compliance was associated with a RR of 0.65 (95% CI, 0.59-0.72). CONCLUSIONS These findings suggest that appropriate narrow-spectrum agents could be more effective than BSAs in preventing SSIs. Interventions to improve SAP compliance with guidelines could significantly contribute to reducing antimicrobial resistance by reducing SSIs and promoting more prudent use of antimicrobials.
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Ierano C, Thursky K, Peel T, Rajkhowa A, Marshall C, Ayton D. Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals. PLoS One 2019; 14:e0225011. [PMID: 31725771 PMCID: PMC6855473 DOI: 10.1371/journal.pone.0225011] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/25/2019] [Indexed: 01/22/2023] Open
Abstract
Background Surgical antimicrobial prophylaxis (SAP) is a leading indication for antibiotic use in the hospital setting, with demonstrated high rates of inappropriateness. Decision-making for SAP is complex and multifactorial. A greater understanding of these factors is needed to inform the design of targeted antimicrobial stewardship interventions and strategies to support the optimization of SAP and its impacts on patient care. Methods A qualitative case study exploring the phenomenon of SAP decision-making. Focus groups were conducted with surgeons, anaesthetists, theatre nurses and pharmacists across one private and two public hospitals in Australia. Thematic analysis was guided by the Theoretical Domains Framework (TDF) and the Capabilities, Opportunities, Motivators-Behaviour (COM-B) model. Results Fourteen focus groups and one paired interview were completed. Ten of the fourteen TDF domains were identified as relevant. Thematic analysis revealed six significant themes mapped to the COM-B model, and subthemes mapped to the relevant TDF domains in a combined framework. Key themes identified were: 1) Low priority for surgical antimicrobial prophylaxis prescribing skills; 2) Prescriber autonomy takes precedence over guideline compliance; 3) Social codes of prescribing reinforce established practices; 4) Need for improved communication, documentation and collection of data for action; 5) Fears and perceptions of risk hinder appropriate SAP prescribing; and 6) Lack of clarity regarding roles and accountability. Conclusions SAP prescribing is a complex process that involves multiple professions across the pre-, intra- and post-operative surgical settings. The utilisation of behaviour change frameworks to identify barriers and enablers to optimal SAP prescribing supports future development of theory-informed antimicrobial stewardship interventions. Interventions should aim to increase surgeon engagement, enhance the prioritisation of and accountability for SAP, and address the underlying social factors involved in SAP decision-making, such as professional hierarchy and varied perceptions or risks and fears.
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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, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
| | - 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, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, 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, Victoria, Australia
- Department of Infectious Diseases, Faculty of Medicine, Nursing and Health Sciences, Alfred Health/Monash University, Melbourne, Victoria, 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, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, 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, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Darshini Ayton
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Ierano C, Thursky K, Marshall C, Koning S, James R, Johnson S, Imam N, Worth LJ, Peel T. Appropriateness of Surgical Antimicrobial Prophylaxis Practices in Australia. JAMA Netw Open 2019; 2:e1915003. [PMID: 31702804 PMCID: PMC6902799 DOI: 10.1001/jamanetworkopen.2019.15003] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Surgical antimicrobial prophylaxis (SAP) is a common indication for antibiotic use in hospitals and is associated with high rates of inappropriateness. OBJECTIVE To describe the SAP prescribing practices and assess hospital, surgical, and patient factors associated with appropriate SAP prescribing. DESIGN, SETTING, AND PARTICIPANTS Multicenter, national, quality improvement study with retrospective analysis of data collected from Australian hospitals via Surgical National Antimicrobial Prescribing Survey audits from January 1, 2016, to June 30, 2018. Data were analyzed using multivariable logistic regression. Crude estimates of appropriateness were adjusted for factors included in the model by calculating estimated marginal means and presented as adjusted-appropriateness with 95% confidence intervals. MAIN OUTCOMES AND MEASURES Adjusted appropriateness and factors associated with inappropriate prescriptions. RESULTS A total of 9351 surgical episodes and 15 395 prescriptions (10 740 procedural and 4655 postprocedural) were analyzed. Crude appropriateness of total prescriptions was 48.7% (7492 prescriptions). The adjusted appropriateness of each surgical procedure group was low for procedural SAP, ranging from 33.7% (95% CI, 26.3%-41.2%) for dentoalveolar surgery to 68.9% (95% CI, 63.2%-74.5%) for neurosurgery. The adjusted appropriateness of postprocedural prescriptions was also low, ranging from 21.5% (95% CI, 13.4%-29.7%) for breast surgery to 58.7% (95% CI, 47.9%-69.4%) for ophthalmological procedures. The most common reason for inappropriate procedural SAP was incorrect timing (44.9%), while duration greater than 24 hours was the most common reason for inappropriate postprocedural SAP (54.3%). CONCLUSIONS AND RELEVANCE High rates of inappropriate procedural and postprocedural antimicrobial use were demonstrated across all surgical specialties. Reasons for inappropriateness, such as timing and duration, varied according to the type of SAP and surgical specialty. These findings highlight the need for improvement in SAP prescribing and suggest potential targeted areas for action.
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Affiliation(s)
- Courtney Ierano
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne, Australia
- University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Karin Thursky
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne, Australia
- University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Caroline Marshall
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne, Australia
- University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Australia
- Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, Australia
| | - Sonia Koning
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne, Australia
| | - Rod James
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne, Australia
| | - Sandra Johnson
- Victorian Healthcare Associated Infection Surveillance System, Melbourne, Australia
| | - Nabeel Imam
- Victorian Healthcare Associated Infection Surveillance System, Melbourne, Australia
| | - Leon J. Worth
- University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Victorian Healthcare Associated Infection Surveillance System, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Trisha Peel
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health/Monash University, Melbourne, Australia
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Ayele Y, Taye H. Antibiotic utilization pattern for surgical site infection prophylaxis at Dil Chora Referral Hospital Surgical Ward, Dire Dawa, Eastern Ethiopia. BMC Res Notes 2018; 11:537. [PMID: 30064490 PMCID: PMC6069961 DOI: 10.1186/s13104-018-3629-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/20/2018] [Indexed: 12/02/2022] Open
Abstract
Objective The aim of this study was to assess utilization pattern of surgical antibiotic prophylaxis in surgical wards of Dil Chora Referral Hospital. Results Prophylactic antibiotics were given in all surgical procedures. More than half of the participants 206(53.6%) were given Ceftriaxone while combination of Ceftriaxone and Metronidazole were used for 159(41.4%) patients. The most common procedure (88.3%), appendectomy, was managed with combination of Ceftriaxone and Metronidazole while the remaining was on Ceftriaxone. Hernia repair, another common procedure seen in this ward, was majorly managed by combination of Ceftriaxone and Metronidazole (60.7%) while the rest were on ceftriaxone alone. In general, inconsistence in antibiotic selection for different types of surgical procedures was seen. The surgical prophylactic antibiotics should be prescribed according to the international guidelines. Electronic supplementary material The online version of this article (10.1186/s13104-018-3629-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yohanes Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia.
| | - Henok Taye
- Dil Chora Referal Hospital, Dire Dawa, Ethiopia
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Sartelli M, Duane TM, Catena F, Tessier JM, Coccolini F, Kao LS, De Simone B, Labricciosa FM, May AK, Ansaloni L, Mazuski JE. Antimicrobial Stewardship: A Call to Action for Surgeons. Surg Infect (Larchmt) 2016; 17:625-631. [PMID: 27828764 DOI: 10.1089/sur.2016.187] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Despite current antimicrobial stewardship programs (ASPs) being advocated by infectious disease specialists and discussed by national and international policy makers, ASPs coverage remains limited to only certain hospitals as well as specific service lines within hospitals. The ASPs incorporate a variety of strategies to optimize antimicrobial agent use in the hospital, yet the exact set of interventions essential to ASP success remains unknown. Promotion of ASPs across clinical practice is crucial to their success to ensure standardization of antimicrobial agent use within an institution. To effectively accomplish this standardization, providers who actively engage in antimicrobial agent prescribing should participate in the establishment and support of these programs. Hence, surgeons need to play a major role in these collaborations. Surgeons must be aware that judicious antibiotic utilization is an integral part of any stewardship program and necessary to maximize clinical cure and minimize emergence of antimicrobial resistance. The battle against antibiotic resistance should be fought by all healthcare professionals. If surgeons around the world participate in this global fight and demonstrate awareness of the major problem of antimicrobial resistance, they will be pivotal leaders. If surgeons fail to actively engage and use antibiotics judiciously, they will find themselves deprived of the autonomy to treat their patients.
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Affiliation(s)
| | - Therese M Duane
- 2 Department of Surgery, John Peter Smith Health Network , Fort Worth, Texas
| | - Fausto Catena
- 3 Department of Emergency Surgery, Maggiore Hospital , Parma, Italy
| | - Jeffrey M Tessier
- 4 Department of Infectious Diseases, John Peter Smith Health Network , Fort Worth, Texas
| | | | - Lillian S Kao
- 6 Department of Surgery, McGovern Medical School, University of Texas Health Science Center , Houston, Texas
| | | | - Francesco M Labricciosa
- 7 Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health , UNIVPM, Ancona, Italy
| | - Addison K May
- 8 Department of Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Luca Ansaloni
- 5 Department of Surgery, Papa XXIII Hospital , Bergamo, Italy
| | - John E Mazuski
- 9 Department of Surgery, Section of Acute and Critical Care Surgery, Washington University School of Medicine , St. Louis, Missouri
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Gouvêa M, Novaes CDEO, Iglesias AC. Assessment of antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital. Rev Col Bras Cir 2016; 43:225-34. [PMID: 27679941 DOI: 10.1590/0100-69912016004001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/04/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE : to evaluate the antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital - HUGG. METHODS : we conducted a rospective study of a cohort of 256 patients undergoing elective operations between January and September 2014. We collected data on demographics, use or not of prophylactic antibiotic and the antibiotic prophylaxis following characteristics: type of antibiotic used, moment of administration and duration of postoperative use. The analyzed outcomes were "justified use or non-use of antibiotic prophylaxis", "correct antibiotic choice," "administration of the antibiotic at the right time" and "discontinuation of the antibiotic at the right time." RESULTS : antibiotic prophylaxis was used in 91.8% of cases. The use or non-use of antibiotic prophylaxis was justified in 78.9% of patients, the choice of the administered antibiotic was considered correct in 97.9%, antibiotic administration was made at the right time in only 27.2% of patients and discontinuation of the antibiotic was performed at the correct time in 95.7% of cases. CONCLUSION : the surgical antibiotic prophylaxis was not fully adequately performed in the sample. OBJETIVO avaliar a antibioticoprofilaxia em pacientes cirúrgicos do Hospital Universitário Gaffrée e Guinle. MÉTODOS estudo prospectivo de uma coorte de 256 pacientes submetidos à operações eletivas, entre janeiro e setembro de 2014. Foram coletados dados demográficos dos pacientes, se ocorreu utilização ou não do antibiótico profilático e as seguintes características da antibioticoprofilaxia: tipo de antibiótico utilizado, momento da administração e tempo de duração do uso no pós-operatório. Os desfechos de interesse analisados foram "uso ou não uso justificado da antibioticoprofilaxia", "escolha correta do antibiótico", "administração do antibiótico no tempo correto" e "descontinuação do antibiótico no tempo correto". RESULTADOS a antibioticoprofilaxia foi utilizada em 91,8% dos casos. O uso ou não uso da antibioticoprofilaxia foi justificado em 78,9% dos pacientes, a escolha do antibiótico administrado foi considerada correta em 97,9%, a administração do antibiótico foi feita no momento correto em apenas 27,2% dos pacientes e a descontinuação do antibiótico foi realizada no tempo correto em 95,7% dos casos. CONCLUSÃO a antibioticoprofilaxia cirúrgica não foi realizada de forma plenamente adequada na amostra estudada.
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Affiliation(s)
- Marise Gouvêa
- - Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO)
| | | | - Antonio Carlos Iglesias
- - Department of General and Specialized Surgery, School of Medicine and Surgery, Federal University of the State of Rio de Janeiro (UNIRIO)
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Adherence to guidelines for surgical antibiotic prophylaxis: a review. Braz J Infect Dis 2015; 19:517-24. [PMID: 26254691 PMCID: PMC9427538 DOI: 10.1016/j.bjid.2015.06.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 11/28/2022] Open
Abstract
Context and objectives The appropriate use of antibiotic prophylaxis in the perioperative period may reduce the rate of infection in the surgical site. The purpose of this review was to evaluate adherence to guidelines for surgical antibiotic prophylaxis. Methods The present systematic review was performed according to the Cochrane Collaboration methodology. The databases selected for this review were: Medline (via PubMed), Scopus and Portal (BVS) with selection of articles published in the 2004–2014 period from the Lilacs and Cochrane databases. Results The search recovered 859 articles at the databases, with a total of 18 studies selected for synthesis. The outcomes of interest analyzed in the articles were as follows: appropriate indication of antibiotic prophylaxis (ranging from 70.3% to 95%), inappropriate indication (ranging from 2.3% to 100%), administration of antibiotic at the correct time (ranging from 12.73% to 100%), correct antibiotic choice (ranging from 22% to 95%), adequate discontinuation of antibiotic (ranging from 5.8% to 91.4%), and adequate antibiotic prophylaxis (ranging from 0.3% to 84.5%). Conclusions Significant variations were observed in all the outcomes assessed, and all the studies indicated a need for greater adherence to guidelines for surgical antibiotic prophylaxis.
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Testa M, Stillo M, Giacomelli S, Scoffone S, Argentero PA, Farina EC, Zotti CM. Appropriate use of antimicrobial prophylaxis: an observational study in 21 surgical wards. BMC Surg 2015; 15:63. [PMID: 25968324 PMCID: PMC4434534 DOI: 10.1186/s12893-015-0048-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 05/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surveillance of Surgical Site Infections (SSI) in 2010 found 39 % compliance with hospital guidelines in Piedmont (Italy). The aim of the study was to estimate the appropriate use of antimicrobial prophylaxis and compliance with hospitals guidelines in surgical wards. METHODS This survey study took place in 21 surgery wards of 4 public hospitals. Forms were completed by public health resident doctors together with a medical ward referent and infection control nurses. 15 consecutive surgical procedures were randomly chosen from each ward. A total of 320 cases were analyzed. The study period was from July 2012 to January 2013. Data were collected using a survey form. A final score variable from 0 to 4 was given to each case. The results were compared with hospital and international guidelines. Data were analyzed using Epi-Info software. RESULTS Of the 320 cases collected, 63 were excluded; of the remaining 257 cases, 56.4 % of the procedures were appropriate (score 4), 15.2 % were acceptable and 28.4 % were not acceptable. The study found an unjustified continuation of antimicrobial prophylaxis in 17.1 % of the 257 cases, an unjustified re-start of antimicrobial therapy in 9.7 % and a re-dosing omission in 7.8 %. CONCLUSIONS The study demonstrated critical problems in antimicrobial prophylaxis management in surgical wards due to a lack of compliance between hospitals and national guidelines, a shortage of specific and updated recommendations for some surgical interventions and incorrect local specific procedures. Coordination between local and national recommendations, strengthening of evidence based decisions and continuous sharing of policy updates are needed.
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Affiliation(s)
- Marco Testa
- School of specialization in Hygiene and Preventive Medicine, Turin, Italy. .,Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - Michela Stillo
- School of specialization in Hygiene and Preventive Medicine, Turin, Italy.,Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Sebastian Giacomelli
- School of specialization in Hygiene and Preventive Medicine, Turin, Italy.,Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Silvia Scoffone
- School of specialization in Hygiene and Preventive Medicine, Turin, Italy.,Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | | | - Enzo Carlo Farina
- Department of General Surgery, City of Science and Health, Turin, Italy
| | - Carla Maria Zotti
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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