Success of an infection control (IC)–led multidisciplinary team to encourage judicious use of surgical antimicrobial prophylaxis (SAP) to prevent surgical site infections (SSIs) and antimicrobial resistance

Objective.To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.Design.An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.Setting.An 88-bed teaching hospital in Entre Ríos, Argentina.Patients.A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.Results.Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30]; P < .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55]; P < .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84]; P < .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79]; P < .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89]; P<.01).Conclusion.The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

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Meta-analysis of the efficacy of ertapenem in preventing SSIs after elective colorectal surgery

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.697 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C Vicentini ◽

A Corradi ◽

S Corcione ◽

F G De Rosa ◽

C M Zotti

Keyword(s):

Colorectal Surgery ◽

Antimicrobial Prophylaxis ◽

Meta Analysis ◽

Carbapenem Resistance ◽

Surgical Site Infections ◽

Resistant Isolate ◽

Elective Colorectal Surgery ◽

Surgical Antibiotic Prophylaxis ◽

Surgical Antimicrobial Prophylaxis ◽

Reported Data

Abstract Background The efficacy of standard surgical antimicrobial prophylaxis (SAP) regimens in preventing surgical site infections (SSIs) after colorectal surgery is declining, along with rising rates of intestinal colonization with antimicrobial resistant (AMR) Enterobacteriaceae and Bacteroides spp. Ertapenem has been approved by the FDA and EMA for SAP in this context, however it has not been used extensively for this indication out of concern for increasing carbapenem-resistance rates. A limited number of studies have investigated the efficacy of ertapenem in preventing SSIs after colorectal surgery, comparing ertapenem with different agents or combinations of agents. Methods A systematic review was conducted following the PRISMA checklist. PubMed, Embase and Cochrane databases were searched for studies measuring the efficacy of ertapenem in preventing SSIs following elective colorectal procedures. Studies were considered eligible if they reported extractable data on the proportion of SSIs and/or on the proportion of AMR pathogens isolated from SSIs. Data from all ertapenem study arms were extracted. A random effects meta-analysis was performed to estimate the overall proportion of SSI. Results Of 1109 identified studies, 5 met the inclusion criteria and were included in the meta-analysis, totalling 3176 participants. The pooled proportion of SSI was 0.10 (95% CI 0.05-0.18; I2=96%; τ2=0.6323; p ≤ 0.01). Only one study reported data on carbapenem resistance: out of 124 isolates from 30 patients, 1 gram negative carbapenem-resistant isolate was identified. Conclusions The pooled proportion of SSI using ertapenem as SAP found in this study is in line with the proportion of SSI using standard SAP found by a recent meta-analysis (Gandra, 2019). According to this analysis, the benefit of ertapenem does not outweigh the risk of further promoting AMR, although results should be interpreted with caution due to the high heterogeneity among included studies. Key messages According to this study, the efficacy of ertapenem in preventing surgical site infections after elective colorectal surgery is comparable to the efficacy of standard surgical antibiotic prophylaxis. The emergence of carbapenem resistance after surgical prophylaxis with ertapenem should be further investigated through longer term studies before widespread use for this indication.

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Reduction in Surgical Antibiotic Prophylaxis Expenditure and the Rate of Surgical Site Infection by Means of a Protocol That Controls the Use of Prophylaxis

Infection Control and Hospital Epidemiology ◽

10.1086/509845 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1358-1365 ◽

Cited By ~ 23

Author(s):

Marisa I. Gómez ◽

Silvia I. Acosta-Gnass ◽

Luisa Mosqueda-Barboza ◽

Juan A Basualdo

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Final Stage ◽

Antimicrobial Prophylaxis ◽

Surgical Site Infections ◽

Site Infection ◽

Infection Rates ◽

Prospective Survey ◽

Surgical Antibiotic Prophylaxis ◽

Surgical Antimicrobial Prophylaxis

Objective.To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.Design.An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.Setting.An 88-bed teaching hospital in Entre Ríos, Argentina.Patients.A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.Results.Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30];P< .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55];P< .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84];P< .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79];P< .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89];P<.01).Conclusion.The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

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Critical National Shortage of Cefazolin in Japan: Management Strategies

Clinical Infectious Diseases ◽

10.1093/cid/ciaa216 ◽

2020 ◽

Vol 71 (7) ◽

pp. 1783-1789 ◽

Cited By ~ 1

Author(s):

Hitoshi Honda ◽

Shutaro Murakami ◽

Yasuharu Tokuda ◽

Yasuaki Tagashira ◽

Akane Takamatsu

Keyword(s):

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Antimicrobial Agents ◽

Antimicrobial Prophylaxis ◽

Management Strategies ◽

Substantial Impact ◽

Comprehensive Plan ◽

Inpatient Settings ◽

Spectrum Activity ◽

Surgical Antimicrobial Prophylaxis

Abstract The shortage of antimicrobials poses a global health threat. In Japan, for instance, the current, critical shortage of cefazolin, a first-line agent for the treatment of common infectious diseases and surgical antimicrobial prophylaxis, has had a substantial impact on inpatient care. A shortage of essential antimicrobial agents like cefazolin leads to increased consumption of alternative antimicrobial agents with broad-spectrum activity, with the unintended consequence of militating against antimicrobial stewardship efforts in inpatient settings and potentially promoting antimicrobial resistance. Although there is global awareness of the shortage of crucial antimicrobials, action to resolve this problem, especially with a view to preventing antimicrobial resistance and promoting antimicrobial stewardship, has been slow, possibly due to the failure to appreciate the urgency of the dilemma. A comprehensive plan for stabilizing antimicrobial access and international collaboration to secure a continuous supply of essential antimicrobials are urgently needed.

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Improving intraoperative administration of surgical antimicrobial prophylaxis: a quality improvement report

BMJ Open Quality ◽

10.1136/bmjoq-2020-001042 ◽

2020 ◽

Vol 9 (3) ◽

pp. e001042

Author(s):

Victoria Haney ◽

Stephan Maman ◽

Jansie Prozesky ◽

Dmitri Bezinover ◽

Kunal Karamchandani

Keyword(s):

Quality Improvement ◽

Antimicrobial Prophylaxis ◽

Surgical Care ◽

Surgical Site Infections ◽

Quality Improvement Initiative ◽

Antibiotic Administration ◽

Prescribing Practices ◽

National Guidelines ◽

Surgical Antimicrobial Prophylaxis ◽

Care Improvement

Despite widespread adoption of the Surgical Care Improvement Programme, the incidence of surgical site infections (SSIs) remains high. It is possible that lapses in appropriate administration of antimicrobial prophylaxis may play a role. We noted significant discordance with national guidelines with regards to intraoperative antibiotic administration at our institution, leading to implementation of a quality improvement initiative using multidisciplinary education and reminder-based interventions to improve prescribing practices and increase compliance with national guidelines. We observed a significant improvement in adherence to all aspects of antibiotic administration guidelines as a result of such interventions. Targeted multidisciplinary interventions may help improve prescribing practices of surgical antimicrobial prophylaxis and provide an opportunity to potentially decrease the burden of SSI and the related morbidity and mortality.

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Do Changes in Antimicrobial Resistance Necessitate Reconsideration of Surgical Antimicrobial Prophylaxis Strategies?

Surgical Infections ◽

10.1089/sur.2008.105 ◽

2009 ◽

Vol 10 (6) ◽

pp. 557-562 ◽

Cited By ~ 6

Author(s):

Matthew E. Falagas ◽

Vangelis G. Alexiou ◽

George Peppas ◽

Gregory C. Makris

Keyword(s):

Antimicrobial Resistance ◽

Antimicrobial Prophylaxis ◽

Surgical Antimicrobial Prophylaxis

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Improvement in Prescribing Habits and Economic Outcomes Associated With the Introduction of a Standardized Approach for Surgical Antimicrobial Prophylaxis

Infection Control and Hospital Epidemiology ◽

10.1086/587811 ◽

2008 ◽

Vol 29 (5) ◽

pp. 457-461 ◽

Cited By ~ 15

Author(s):

Elizabeth D. Hermsen ◽

Sara Smith Shull ◽

Susan E. Puumala ◽

Mark E. Rupp

Keyword(s):

Antimicrobial Prophylaxis ◽

Surgical Site Infections ◽

Economic Outcomes ◽

Surgical Prophylaxis ◽

Prescribing Habits ◽

Order Form ◽

Quasi Experimental ◽

Antibiotic Duration ◽

Surgical Antimicrobial Prophylaxis ◽

The Impact

A quasi-experimental before-after study was conducted to determine the impact on prescribing habits and economic outcomes of an intervention that required use of an order form for surgical antimicrobial prophylaxis. Implementation of this intervention improved compliance with guidelines for prevention of surgical site infections, particularly with respect to choice of antibiotic, duration of use, and dosage, and resulted in decreased cost of surgical prophylaxis.

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Implementation of Antimicrobial Stewardship Measures in Cardiac Surgery: Change of Protocol for Surgical Antibiotic Prophylaxis and Its Impact on Surgical Site Infections

10.21203/rs.3.rs-80948/v1 ◽

2020 ◽

Author(s):

Güzin Surat ◽

Dominik Bernsen ◽

Christoph Schimmer

Keyword(s):

Cardiac Surgery ◽

Antimicrobial Stewardship ◽

Antimicrobial Prophylaxis ◽

Tertiary Care ◽

Surgical Site Infections ◽

Care Hospital ◽

Wound Infections ◽

Surgical Antimicrobial Prophylaxis ◽

Tract Infections ◽

The Impact

Abstract Objectives:The goal of this study was to evaluate the impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery comparing the new in hospital prophylactic agent cefazolin versus the former standard antibiotic cefuroxime, initiated by the antimicrobial stewardship team. Methods: This retrospective observational study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the antimicrobial stewardship team following a new recommendation of the surgical antimicrobial prophylaxis and included 1029 patients who underwent cardiac surgery. Two patient groups including 582 patients receiving Cefuroxime and 447 patients receiving Cefazolin respectively were compared without altering any other preventative perioperative measures. Adherence, overall infection rates, leg wound infections and deep sternal wound infections were compiled and analysed as well as a broad profile of preoperative, intraoperative and postoperative patient data. Results:A complete adherence on the change of the agent was achieved.Overall surgical site infections occurred in 37 (6.6%) of the cases, with 20 (3,4%) SSI 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 and secondary endpoints including DSWI (2,1% for cefuroxime, 1,3% for cefazolin), vein harvesting site infections (1,2% for cefuroxime, 2,2% for cefazolin) as well as urinary tract infections, pneumonia, sepsis and overall mortality of all causes. Conclusions:These results demonstrate that compliance to antimicrobial stewardship standards is not associated with more surgical site infections.

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Antimicrobial stewardship measures in cardiac surgery and its impact on surgical site infections

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01693-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Güzin Surat ◽

Dominik Bernsen ◽

Christoph Schimmer

Keyword(s):

Cardiac Surgery ◽

Antimicrobial Stewardship ◽

Antimicrobial Prophylaxis ◽

Tertiary Care ◽

Surgical Site Infections ◽

Antibiotic Use ◽

P Value ◽

Care Hospital ◽

Surgical Antimicrobial Prophylaxis ◽

Sternal Wound Infections

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.

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Therapy-related issues: infections

10.1093/med/9780199603640.003.0020 ◽

2012 ◽

Author(s):

Philip Wiffen ◽

Marc Mitchell ◽

Melanie Snelling ◽

Nicola Stoner

Keyword(s):

Antimicrobial Resistance ◽

Infection Control ◽

Antimicrobial Prophylaxis ◽

Antimicrobial Use ◽

Antimicrobial Prescribing ◽

Modes Of Action ◽

Micro Organisms

Basic microbiology 412Modes of action of antibacterials 416Selection and use of antimicrobials 418Antimicrobial prophylaxis 428Optimizing antimicrobial use 430Antimicrobial prescribing guidelines 432Antimicrobial resistance 436Infection control 440Micro-organisms are classified in many ways. The most important classifications are as follows. ...

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