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Yang Y, Zhang L, Wang J, Chen Z, Tong L, Wang Z, Li G, Luo Y. Proportions of Pseudomonas aeruginosa and Antimicrobial-Resistant P aeruginosa Among Patients With Surgical Site Infections in China: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2024; 11:ofad647. [PMID: 38328500 PMCID: PMC10847825 DOI: 10.1093/ofid/ofad647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/16/2023] [Indexed: 02/09/2024] Open
Abstract
Background Pseudomonas aeruginosa is one of the most common pathogens in surgical site infections (SSIs). However, comprehensive epidemiological and antibiotic resistance details for P aeruginosa in Chinese SSIs are lacking. We evaluated the proportions and antimicrobial resistance of P aeruginosa among patients with SSIs in China. Methods Relevant papers from January 2010 to August 2022 were searched in databases including PubMed, Embase, Web of Science, China Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang, and Weipu. A meta-analysis was performed to analyze the proportions and 95% confidence interval (CIs) of P aeruginosa among patients with SSIs. Meta-regression analysis was used to investigate the proportion difference among different subgroups and antimicrobial resistance. Results A total of 72 studies met inclusion criteria, involving 33 050 isolated strains. The overall proportion of P aeruginosa among patients with SSIs was 16.0% (95% CI, 13.9%-18.2%). Subgroup analysis showed higher proportions in orthopedic (18.3% [95% CI, 15.6%-21.0%]) and abdominal surgery (17.3% [95% CI, 9.9%-26.2%]). The proportion in the central region (18.6% [95% CI, 15.3%-22.1%]) was slightly higher than that in other regions. Antibiotic resistance rates significantly increased after 2015: cefoperazone (36.2%), ceftriaxone (38.9%), levofloxacin (20.5%), and aztreonam (24.0%). Notably, P aeruginosa resistance to ampicillin and cefazolin exceeded 90.0%. Conclusions The proportion of P aeruginosa infection among patients with SSIs was higher than the data reported by the Chinese Antimicrobial Resistance Surveillance System, indicating rising antimicrobial resistance. The existing antimicrobial drug management plan should be strengthened to prevent a hospital epidemic of drug-resistant P aeruginosa strains.
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Affiliation(s)
- Yuhui Yang
- School of Nursing, Army Medical University, Chongqing, China
| | - Li Zhang
- Disease Surveillance Division, Center for Disease Control and Prevention of Central Theater Command, Beijing, China
| | - Jian Wang
- Department of Prevention and Control of Infectious Diseases, Center for Disease Control and Prevention of Central Theater Command, Beijing, China
| | - Zongyue Chen
- School of Nursing, Army Medical University, Chongqing, China
| | - Liang Tong
- Disease Surveillance Division, Center for Disease Control and Prevention of Central Theater Command, Beijing, China
| | - Zhenkun Wang
- Disease Surveillance Division, Center for Disease Control and Prevention of Central Theater Command, Beijing, China
| | - Gaoming Li
- Disease Surveillance Division, Center for Disease Control and Prevention of Central Theater Command, Beijing, China
| | - Yu Luo
- School of Nursing, Army Medical University, Chongqing, China
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Stavropoulou E, Atkinson A, Eisenring MC, Fux CA, Marschall J, Senn L, Troillet N. Association of antimicrobial perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in colorectal surgery. Antimicrob Resist Infect Control 2023; 12:105. [PMID: 37726838 PMCID: PMC10510121 DOI: 10.1186/s13756-023-01307-y] [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: 03/20/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE To compare intravenous (IV) amoxicillin/clavulanic acid (A/CA) to IV cefuroxime plus metronidazole (C + M) for preventing surgical site infections (SSI) in colorectal surgery. BACKGROUND Given their spectra that include most Enterobacterales and anaerobes, C + M is commonly recommended as prophylaxis of SSI in colorectal surgery. A/CA offers good coverage of Enterobacterales and anaerobes as well, but, in contrast to C + M, it also includes Enterococcus faecalis which is also isolated from patients with SSI and could trigger anastomotic leakage. METHODS Data from a Swiss SSI surveillance program were used to compare SSI rates after class II (clean contaminated) colorectal surgery between patients who received C + M and those who received A/CA. We employed multivariable logistic regression to adjust for potential confounders, along with propensity score matching to adjust for group imbalance. RESULTS From 2009 to 2018, 27,922 patients from 127 hospitals were included. SSI was diagnosed in 3132 (11.2%): 278/1835 (15.1%) in those who received A/CA and 2854/26,087 (10.9%) in those who received C + M (p < 0.001). The crude OR for SSI in the A/CA group as compared to C + M was 1.45 [CI 95% 1.21-1.75]. The adjusted OR was 1.49 [1.24-1.78]. This finding persisted in a 1:1 propensity score matched cohort of 1835 patients pairs with an OR of 1.60 [1.28-2.00]. Other factors independently associated with SSI were an ASA score > 2, a longer duration of operation, and a reoperation for a non-infectious complication. Protective factors were female sex, older age, antibiotic prophylaxis received 60 to 30 min before surgery, elective operation, and endoscopic approach. CONCLUSIONS Despite its activity against enterococci, A/CA was less effective than C + M for preventing SSI, suggesting that it should not be a first choice antibiotic prophylaxis for colorectal surgery.
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Affiliation(s)
- Elisavet Stavropoulou
- Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Christine Eisenring
- Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
- Swissnoso, National Center for Infection Prevention, Bern, Switzerland
| | - Christoph A Fux
- Division of Infectious Diseases and Infection Prevention, Kantonsspital Aarau, Aarau, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Laurence Senn
- Swissnoso, National Center for Infection Prevention, Bern, Switzerland.
- Infection Prevention and Control Unit, Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
- Swissnoso, National Center for Infection Prevention, Bern, Switzerland
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Im JH, Lee DY, Baek JH, Lee SJ, Jung S, Kim E, Kang DY, Lee JS. Comparison of Cefazolin/Metronidazole to Ampicillin/Sulbactam as Preoperative Antibiotics in Colorectal Surgery: A Retrospective, Single-Center Cohort Study. Antibiotics (Basel) 2023; 12:1381. [PMID: 37760678 PMCID: PMC10525786 DOI: 10.3390/antibiotics12091381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
AIM The use of prophylactic antibiotics prior to colorectal surgery reduces surgical site infections. Cefazolin and metronidazole are used as a standard regimen. Ampicillin/sulbactam may be an alternative, but current data are limited. We compared the efficacy of ampicillin/sulbactam with cefazolin and metronidazole as prophylactic antibiotics. METHODS Patients who underwent colorectal surgery at Inha University Hospital between 2010 and 2020 were treated prophylactically with cefazolin and metronidazole or ampicillin/sulbactam, and observed for 30 days following surgery. The primary outcome was surgical site infections. The secondary outcomes were deep/organ infections and the need for drainage. RESULTS SSIs occurred in 2.6% (17/646) of the ampicillin/sulbactam group, whose rate was not inferior to the occurrence in the group receiving cefazolin and metronidazole (3.8%, 21/556). There was no significant difference between the two groups in the secondary outcomes. CONCLUSIONS Compared to the cefazolin and metronidazole combination, ampicillin/sulbactam is not inferior as a preoperative prophylactic antibiotic regimen for colorectal surgery.
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Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon 22212, Republic of Korea; (J.H.I.); (J.H.B.); (S.J.L.)
| | - Dong Yeop Lee
- Department of Preventive Medicine, Ulsan University Hospital, Ulsan 44033, Republic of Korea;
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon 22212, Republic of Korea; (J.H.I.); (J.H.B.); (S.J.L.)
| | - Se Ju Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon 22212, Republic of Korea; (J.H.I.); (J.H.B.); (S.J.L.)
| | - Sungtaek Jung
- Department of General Surgery, Shihwa Hospital, Siheung 15034, Republic of Korea;
| | - Eunjung Kim
- Infection Control Unit, Inha University Hospital, Incheon 22212, Republic of Korea;
| | - Dong Yoon Kang
- Department of Preventive Medicine, Ulsan University Hospital, Ulsan 44033, Republic of Korea;
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon 22212, Republic of Korea; (J.H.I.); (J.H.B.); (S.J.L.)
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Aldriwesh MG, Alnodley A, Almutairi N, Algarni M, Alqarni A, Albdah B, Mashraqi M. Prevalence, Microbiological Profile, and Risk Factors of Surgical Site Infections in Saudi Patients with Colorectal Cancer. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:208-218. [PMID: 37533658 PMCID: PMC10393088 DOI: 10.4103/sjmms.sjmms_3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/27/2023] [Accepted: 06/11/2023] [Indexed: 08/04/2023]
Abstract
Background Resection surgery in patients with colorectal cancer (CRC) patients is associated with potential complications, including surgical site infection (SSI). Objectives To estimate the prevalence rate of SSI, identify the common pathogens responsible for SSI, and determine potential risk factors for SSI development in a cohort from Saudi Arabia. Materials and Methods Patients with CRC who underwent bowel resection surgery at King Abdulaziz Medical City, Riyadh, between January 01, 2016, and December 31, 2019, were retrospectively included. Demographics, comorbidities, surgical procedure data, and the results of preoperative laboratory tests were retrospectively collected from medical records through the health information system. The study population was divided into two groups: those who developed SSI and those who did not. Results A total of 92 patients with CRC who underwent resection surgery were included, of which 54 (58.7%) were males. The median age was 65 (IQR 55.5-75.0) years. SSI was observed in 25 (27.2%) patients. The most frequently isolated organisms were Escherichia coli and Pseudomonas aeruginosa, followed by Klebsiella pneumoniae, vancomycin-sensitive Enterococcus faecium, and methicillin-resistant Staphylococcus aureus. Three E. coli isolates were producers of extended-spectrum beta-lactamases, and two K. pneumoniae isolates exhibited a multidrug resistance profile. Low preoperative serum albumin level was identified as a significant independent risk factor for developing SSI (AOR = 0.853, 95% CI = 0.748-0.973, P = 0.0181). Conclusion The study found a notable prevalence of SSI among the included patients. Gram-negative bacteria were more involved in SSI events and were also associated with drug-resistance patterns. Gut microbiota bacteria were most commonly involved in SSIs. Low preoperative serum albumin levels predicted the development of postoperative SSI, and thus its close monitoring and management before surgery could reduce the SSIs.
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Affiliation(s)
- Marwh Gassim Aldriwesh
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard–Health Affairs, Riyadh, Saudi Arabia
| | - Abrar Alnodley
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Norah Almutairi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Algarni
- King Abdullah International Medical Research Center, Ministry of National Guard–Health Affairs, Riyadh, Saudi Arabia
- Department of Oncology, Ministry of National Guard–Health Affairs, Riyadh, Saudi Arabia
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ayyob Alqarni
- King Abdullah International Medical Research Center, Ministry of National Guard–Health Affairs, Riyadh, Saudi Arabia
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of General Surgery, Ministry of National Guard–Health Affairs, Riyadh, Saudi Arabia
| | - Bayan Albdah
- Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mutaib Mashraqi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
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Heffernan JM, McLaren AC, Overstreet DJ. Local antimicrobial delivery from temperature-responsive hydrogels reduces incidence of intra-abdominal infection in rats. Comp Immunol Microbiol Infect Dis 2022; 86:101823. [PMID: 35636372 PMCID: PMC9430827 DOI: 10.1016/j.cimid.2022.101823] [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: 02/07/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
The objective of this study was to evaluate local antimicrobial delivery from temperature-responsive hydrogels for preventing infection in a rat model of intra-abdominal infection (IAI), and to determine whether delivery of tobramycin and vancomycin in combination is effective against IAI pathogens. Rats received intraperitoneal inoculation of E. coli, rat cecal contents, or cecal contents supplemented with E. coli, and received either no treatment, subcutaneous cefoxitin, or local delivery from hydrogels containing vancomycin, tobramycin, or both antimicrobials. Only the hydrogel with tobramycin and vancomycin significantly increased the infection free-rate compared to no treatment for all inocula (E. coli: 13/17, p < 0.0001; cecal contents: 11/17, p = 0.0013; cecal contents + E. coli: 15/19, p < 0.0001). Additionally, tobramycin and vancomycin displayed no synergy or antagonism against clinical isolates in vitro. Local delivery of tobramycin and vancomycin from temperature-responsive hydrogels provides broad coverage and high antimicrobial concentrations for several hours that may be effective for preventing IAIs.
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Affiliation(s)
| | - Alex C McLaren
- Sonoran Biosciences, 1048 E Knight Ln, Tempe, AZ, USA; University of Arizona College of Medicine, 475N 5th St, Phoenix, AZ, USA.
| | - Derek J Overstreet
- Sonoran Biosciences, 1048 E Knight Ln, Tempe, AZ, USA; Arizona State University, PO Box 879709, Tempe, AZ, USA.
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Strobel RM, Leistner R, Leonhardt M, Neumann K, Eschlböck SM, Lee LDG, Seifarth C, Schineis CHW, Kamphues C, Weixler B, Beyer K, Lauscher JC. Is There an Association between Intra-Operative Detection of Pathogens in Subcutaneous Tissue and Surgical Site Infections? Results from a Prospective Study. Surg Infect (Larchmt) 2022; 23:372-379. [PMID: 35263172 DOI: 10.1089/sur.2021.154] [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: 11/13/2022] Open
Abstract
Background: Surgical site infections (SSIs) are a common complication in visceral surgery. Pathogens causing SSIs vary depending on the type of surgery. Patients and Methods: Within the scope of the Reduction of Postoperative Wound Infections by Antiseptica (RECIPE) trial we analyzed the pathogens cultured in intra-operative, subcutaneous swabs and in swabs from SSI in a single-center, prospective, randomized controlled study. Definition of SSI complied with the criteria of the U.S. Centers for Disease Control and Prevention (CDC). Results: The overall rate of SSI was 28.2% in 393 patients. Colorectal surgery was performed in 68.2% of elective laparotomies. Pathogens were more often detected in intra-operative subcutaneous swabs in patients who developed SSIs than in patients who did not develop SSIs (64.4% vs. 38.0%; p < 0.001). Enterococci were found in 29.1% of intra-operative swabs in patients with SSIs, followed by Escherichia coli in 15.5%. A higher rate of Enterococcus faecium was found in patients with anemia versus those without anemia (9.2% vs. 2.3%; p = 0.006) and in patients who smoked versus those who did not (11.8% vs. 3.6%; p = 0.008). A positive subcutaneous swab (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.47-4.29; p = 0.001), pre-operative anemia (OR, 1.84; 95% CI, 1.08-3.13; p = 0.016), and renal insufficiency (OR, 2.15; 95% CI, 1.01-4.59; p = 0.048) were risk factors for SSIs. Conclusions: There is an association between the intra-operative detection of pathogens in subcutaneous tissue and the development of SSIs in visceral surgery. The most prevalent pathogens causing SSIs were enterococci and Escherichia coli. More efforts are justified to reduce subcutaneous colonization with pathogens, for example by using intra-operative wound irrigation with polyhexanide solution. This trial is registered at www.ClinicalTrials.gov (ID: NCT04055233).
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Affiliation(s)
- Rahel M Strobel
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Rasmus Leistner
- Department of Gastroenterology, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Marja Leonhardt
- Innlandet Hospital Trust, Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Brumunddal, Norway
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Sophie M Eschlböck
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Lucas D G Lee
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Claudia Seifarth
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Christian H W Schineis
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Carsten Kamphues
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Benjamin Weixler
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Katharina Beyer
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Johannes C Lauscher
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
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Dixon L, Biggs S, Messenger D, Shabbir J. Surgical Site Infection (SSI) Prevention Bundle in Elective Colorectal Surgery. J Hosp Infect 2022; 122:162-167. [DOI: 10.1016/j.jhin.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
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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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