Antibiotic appropriateness and adherence to local guidelines in perioperative prophylaxis: results from an antimicrobial stewardship intervention

Abstract Objectives Surgical antibiotic prophylaxis (SAP) represents a major indication of antibiotic consumption worldwide. The present study aims to report the results of an enabling, long-term AMS intervention conducted between 2013 and 2019 on an Italian University Hospital performing more than 40.000 surgical interventions per year. Methods SAP inappropriateness was defined according to the ASHP guidelines and divided in four main categories: indication, selection and dosing, duration, timing. Between 2013 and 2019, we conducted a continuative AMS intervention over 14 surgical departments that included enablement, review of selected clinical records and feedback. Results We collected a total of 789 SAP prescribed to 735 patients (mean age 56.7 ± 17.8y). Overall, guideline adherence improved from 36.6% (n = 149) at baseline to 57.9% (n = 221) post-intervention (P < 0.0001). A significant improvement (P < 0.001) was also detected for each category: indication (from 58.5 to 93.2%), selection and dosing (from 58.5 to 80.6%), timing (from 92.4 to 97.6%), duration (from 71 to 80.1%). Conclusions Though results cannot be generalized to all hospital populations, enabling AMS interventions may be effective in establishing a sustained improvement in SAP appropriateness rates. Once identified the main causes of SAP inappropriateness, tailored AMS interventions for each department may be beneficial. Further studies are needed to evaluate specific outcomes as incidence of surgical site infections and antimicrobial resistance.

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Antibiotic Appropriateness and Adherence to Local Guidelines in Perioperative Prophylaxis: Results from an Antimicrobial Stewardship Intervention

10.21203/rs.3.rs-41134/v1 ◽

2020 ◽

Author(s):

Francesco Vladimiro Segala ◽

Rita Murri ◽

Eleonora Taddei ◽

Francesca Giovannenze ◽

Pierluigi Del Vecchio ◽

...

Keyword(s):

Surgical Site Infections ◽

Antibiotic Consumption ◽

University Hospital ◽

Post Intervention ◽

Sustained Improvement ◽

Surgical Interventions ◽

Perioperative Prophylaxis ◽

Surgical Antibiotic Prophylaxis ◽

Clinical Records

Abstract Objectives: Surgical antibiotic prophylaxis (SAP) represents a major indication of antibiotic consumption worldwide. The present study aims to report the results of an enabling, long-term AMS intervention conducted between 2013 and 2019 on an Italian University Hospital performing more than 40.000 surgical interventions per year.Methods: SAP inappropriateness was defined according to the ASHP guidelines and divided in four main categories: indication, selection and dosing, duration, timing. Between 2013 and 2019, we conducted a continuative AMS intervention over 14 surgical departments that included enablement, review of selected clinical records and feedback. Results: We collected a total of 789 SAP prescribed to 735 patients (mean age 56.7 ± 17.8y). Overall, guideline adherence improved from 36.6% (n = 149) at baseline to 57.9% (n = 221) post-intervention (P<0.0001). A significant improvement (P<0.001) was also detected for each category: indication (from 58.5% to 93.2%), selection and dosing (from 58.5% to 80.6%), timing (from 92.4 to 97.6%), duration (from 71% to 80.1%). Conclusions: Though results cannot be generalized to all hospital populations, enabling AMS interventions may be effective in establishing a sustained improvement in SAP appropriateness rates. Once identified the main causes of SAP inappropriateness, tailored AMS interventions for each department may be beneficial. Further studies are needed to evaluate specific outcomes as incidence of surgical site infections and antimicrobial resistance.

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The “Torment” of Surgical Antibiotic Prophylaxis among Surgeons

Antibiotics ◽

10.3390/antibiotics10111357 ◽

2021 ◽

Vol 10 (11) ◽

pp. 1357

Author(s):

Massimo Sartelli ◽

Federico Coccolini ◽

Angeloantonio Carrieri ◽

Francesco M. Labricciosa ◽

Enrico Cicuttin ◽

...

Keyword(s):

Acute Kidney Injury ◽

Side Effects ◽

Antibiotic Prophylaxis ◽

Kidney Injury ◽

Surgical Site Infections ◽

Surgical Interventions ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Surgical Antibiotic Prophylaxis ◽

Operative Measures

Surgical antibiotic prophylaxis (SAP) is one of the peri-operative measures for preventing surgical site infections (SSIs). Its goal is to counteract the proliferation of bacteria in the surgical site during intervention in order to reduce the risk of SSIs. SAP should be administered for surgical interventions where the benefit expected (prevention of SSIs) is higher compared to the risk (serious side effects, such as acute kidney injury, Clostridioides difficile infection, and the spread of antimicrobial resistance). In prescribing SAP, surgeons should have both the awareness necessary “to handle antibiotics with care”, and the knowledge required to use them appropriately.

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Long-Term Carbapenems Antimicrobial Stewardship Program

Antibiotics ◽

10.3390/antibiotics10010015 ◽

2020 ◽

Vol 10 (1) ◽

pp. 15

Author(s):

José Francisco García-Rodríguez ◽

Belén Bardán-García ◽

Pedro Miguel Juiz-González ◽

Laura Vilariño-Maneiro ◽

Hortensia Álvarez-Díaz ◽

...

Keyword(s):

Ecological Impact ◽

Bloodstream Infections ◽

Antibiotic Consumption ◽

Multidrug Resistant ◽

Audit And Feedback ◽

Post Intervention ◽

Stewardship Program ◽

Prospective Audit And Feedback ◽

Hospital Acquired

Objective. To evaluate clinical and antibiotic resistance impact of carbapenems stewardship programs. Methods: descriptive study, pre-post-intervention, between January 2012 and December 2019; 350-bed teaching hospital. Prospective audit and feedback to prescribers was carried out between January 2015 and December 2019. We evaluate adequacy of carbapenems prescription to local guidelines and compare results between cases with accepted or rejected intervention. Analysis of antibiotic-consumption and hospital-acquired multidrug-resistant (MDR) bloodstream infections (BSIs) was performed. Results: 1432 patients were followed. Adequacy of carbapenems prescription improved from 49.7% in 2015 to 80.9% in 2019 (p < 0.001). Interventions on prescription were performed in 448 (31.3%) patients without carbapenem-justified treatment, in 371 intervention was accepted, in 77 it was not. Intervention acceptance was associated with shorter duration of all antibiotic treatment and inpatient days (p < 0.05), without differences in outcome. During the period 2015–2019, compared with 2012–2014, decreased meropenem consumption (Rate Ratio 0.58; 95%CI: 0.55–0.63), candidemia and hospital-acquired MDR BSIs rate (RR 0.62; 95%CI: 0.41–0.92, p = 0.02), and increased cefepime (RR 2; 95%CI: 1.77–2.26) and piperacillin-tazobactam consumption (RR 1.17; 95%CI: 1.11–1.24), p < 0.001. Conclusions: the decrease and better use of carbapenems achieved could have clinical and ecological impact over five years, reduce inpatient days, hospital-acquired MDR BSIs, and candidemia, despite the increase in other antibiotic-consumption.

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A Retrospective Analysis of the Palliative Surgical Treatment in Patients with Malignant Pleural Effusion

Acta Medica Martiniana ◽

10.2478/acm-2021-0003 ◽

2021 ◽

Vol 21 (1) ◽

pp. 13-20

Author(s):

G Krajnakova ◽

A Dzian ◽

M Skalicanova ◽

L Hamada ◽

M Malik ◽

...

Keyword(s):

Pleural Effusion ◽

Median Survival ◽

Malignant Pleural Effusion ◽

Performance Status ◽

University Hospital ◽

Talc Pleurodesis ◽

Term Survival ◽

Advanced Malignancy ◽

Surgical Interventions

Abstract Introduction: The formation of malignant pleural effusion (MPE) is a clinical manifestation of an advanced malignancy or its dissemination. The focus of treatment is primarily palliative and aimed at relieving symptoms, especially dyspnoea. Material and Methods: Clinical data from patients who were hospitalized at the Clinic of Thoracic Surgery, JFMED CU and Martin University Hospital, in the years 2015–2019 were retrospectively explored and statistically analyzed based on their medical records. Results: From the group of patients with proven MPE (n=67), 32 patients were male (48%) and 35 were female (52%). The mean age was 62.3 years (65.4 for males and 59.4 for females). The three most common primary malignancies were lung cancer (n=24), breast cancer (n=14), and kidney cancer (n=6). In 38 patients with MPE a talc pleurodesis via VATS was performed, with a median survival of 341 days (95% CI 256–859). Drainage following the talc slurry pleurodesis was performed in 10 patients with a median survival of 91.5 days (95% CI 64-NA). Ten patients with MPE underwent drainage only. The overall median survival time after all types of surgical interventions was 301 days (95% CI 207-389 days). Conclusion: Management of MPE depends on the patient´s prognosis. A definitive intervention is required in patients with a long-term survival, while in patients with a short life expectancy procedures leading to the shortest hospital stay are preferred. Videothoracoscopic procedures with pleurodesis represent an effective treatment for patients with symptomatic MPE with a good performance status, presence of lung re-expansion following pleural drainage or expected survival.

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Study Protocol: Prospective, observational, cohort study of COVID-19 in General Practice (North Dublin COVID-19 Cohort [‘ANTICIPATE’] Study)

HRB Open Research ◽

10.12688/hrbopenres.13135.1 ◽

2020 ◽

Vol 3 ◽

pp. 67

Author(s):

Walter Cullen ◽

Gordana Avramovic ◽

John Broughan ◽

Mary-Carmel Burke ◽

Aoife Cotter ◽

...

Keyword(s):

Mental Health ◽

General Practice ◽

Health Service ◽

Health Behaviours ◽

University Hospital ◽

Service Utilisation ◽

Presumptive Diagnosis ◽

Health And Wellbeing ◽

Clinical Records

Background: It is accepted that COVID-19 will have considerable long-term consequences, especially on people’s mental and physical health and wellbeing. Although the impacts on local communities have been immense, there remains little data on long term outcomes among patients with COVID-19 who were managed in general practice and primary care. This study seeks to address this knowledge gap by examining how the COVID-19 pandemic has impacted the medium and long-term health and wellbeing of patients attending general practice, especially their mental health and wellbeing. Methods: The study will be conducted at 12 general practices in the catchment area of the Mater Misericordiae University Hospital, i.e. the North Dublin area, an area which has experienced an especially high COVID-19 incidence. Practices will be recruited from the professional networks of the research team. A member of the general practice team will be asked to identify patients of the practice who attended the practice after 16/3/20 with a confirmed or presumptive diagnosis of COVID-19 infection. Potential participants will be provided with information on the study by the clinical team. Data will be collected on those patients who consent to participate by means of an interviewer-administered questionnaire and review of clinical records. Data will be collected on health (especially mental health) and wellbeing, quality of life, health behaviours, health service utilisation, and wider impacts of COVID-19 at recruitment and at two follow up time points (6, 12 months). Deliverables: The project involves collaboration with Ireland’s Health Service Executive, Ireland East Hospital Group, and the Mater Misericordiae University Hospital, Dublin. The study is funded by the Health Research Board. Findings will inform health policies that attenuate the adverse impacts of COVID-19 on population mental health and health generally.

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Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery

Pathogens ◽

10.3390/pathogens9060490 ◽

2020 ◽

Vol 9 (6) ◽

pp. 490 ◽

Cited By ~ 1

Author(s):

Daniele Donà ◽

Dora Luise ◽

Elisa Barbieri ◽

Nicola Masiero ◽

Sonia Maita ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Pediatric Surgery ◽

Tertiary Care ◽

Surgical Site Infections ◽

Secondary Outcome ◽

Antimicrobial Stewardship Program ◽

Post Intervention ◽

Stewardship Program ◽

Surgery Center

Background—Appropriate perioperative antibiotic prophylaxis (PAP) is essential to prevent surgical site infections (SSIs) and to avoid antibiotics misuse. Aim—The aim of this study is to determine the effectiveness and long-term sustainability of an antimicrobial stewardship program (ASP), based on a clinical pathway (CP) and periodic education, to improve adherence to the guidelines for PAP in a tertiary care pediatric surgery center. Methods—We assessed the changes in PAP correctness and its effect on SSIs between the six months before and the 24 months after the implementation of ASP in the Pediatric Surgery Unit of the Department of Women’s and Children’s Health of Padova. The ASP was addressed to all surgeons and anesthesiologists of the Pediatric Surgery Unit. The primary outcome was appropriateness of PAP (agent, timing of the first dose, and duration). SSI rate was the secondary outcome. Results—1771 patients were included in the study and 676 received PAP. The overall correctness of the PAP, in terms of agent, timing, and duration, increased significantly after the CP implementation. What changed most was the PAP discontinuation within 24 h (p < 0.001). Cefazolin was the most used antibiotic, with a significant increase in the post-intervention period (p < 0.001) and with a reduction in the use of other broad-spectrum antibiotics. No variations in the incidence of SSIs were reported in the five periods (p = 0.958). Conclusion—The implementation of an ASP based on CP and education is an effective and sustainable antimicrobial stewardship tool for improving the correct use of PAP.

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Surgical Sites Infection After Gastrointestinal Surgeries in a Public Teaching Hospital in Sudan

10.21203/rs.3.rs-59531/v1 ◽

2020 ◽

Author(s):

Rawan Sharaf Eldein Elamein Hassan ◽

Sarah Osman Sayed Osman ◽

Mohamed Abdulmonem Salih Aabdeen ◽

Walid Elhaj Abdelrahim Mohamed ◽

Razan Sharaf Eldein Elamein Hassan ◽

...

Keyword(s):

Associated Factors ◽

Financial Burden ◽

Operation Time ◽

Surgical Site Infections ◽

University Hospital ◽

Categorical Variables ◽

Cross Sectional ◽

Significance Level ◽

Surgical Interventions ◽

E Coli

Abstract Background: Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays, additional financial burden, and significantly hamper the potential benefits of surgical interventions. Causes of SSIs are multi-factorials and patients undergoing gastrointestinal tract (GIT) procedures carry a high risk of bacterial contamination. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing GIT surgeries.Methods: A hospital based, cross-sectional study conducted at Soba University Hospital (SUH) in Khartoum, Sudan. We included all patients from all age groups attending the GIT surgical unit at SUH between September-December 2017. We collected data about the socio-demographic characteristics, risk factors of SSI, and isolated microorganisms from patients with SSIs. Data analysis was done using the SPSS software version 20 (SPSS Inc., Chicago, IL, USA). A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p < .05.Results: A total of 80 participants were included in the study. The mean age was 51 +/- 16 years and most of the patients (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) of them underwent large bowel surgery. Twenty-two patients (27.5%) developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p > .001), malignant nature of the disease (p > .001), intra-operative blood loss (p > .001), and intra-operative hypotension (p =.013). The most prevalent microorganism isolated from SSI patients was E coli (47.8%), followed by Enterococcus fecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%).Conclusion: The results showed a high prevalence of SSIs among patients attending the GIT unit in SUH and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.

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HOSPITAL INFECTION IN SURGICAL DEPARTMENTS AT HUE UNIVERSITY HOSPITAL IN 2015

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2016.5.6 ◽

2016 ◽

pp. 39-43

Author(s):

Dinh Binh Tran ◽

Dinh Tan Tran

Keyword(s):

Surgical Site Infection ◽

Surgical Intervention ◽

University Hospital ◽

Hospital Infections ◽

Site Infection ◽

Cross Sectional ◽

Surgical Interventions ◽

Hospital Acquired Infections ◽

Tract Infections ◽

Hospital Acquired

Objective: To study nosocomial infections and identify the main agents causing hospital infections at Hue University Hospital. Subjects and Methods: A cross-sectional descriptive study of 385 patients with surgical interventions. Results: The prevalence of hospital infections was 5.2%, surgical site infection was the most common (60%), followed by skin and soft tissue infections (35%), urinary tract infections (5%). Surgical site infection (11.6%) in dirty surgery. There were 3 bacterial pathogens isolated, including Staphylococcus aureus (50%), Pseudomonas aeruginosa and Enterococcusspp (25%). Conclusion: Surgical site infection was high in hospital-acquired infections. Key words: hospital infections, surgical intervention, surgical site infection, bacteria

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Health education through mass media announcements by loudspeakers about malaria care: prevention and practice among people living in a malaria endemic area of northern Myanmar

Malaria Journal ◽

10.1186/s12936-019-2985-6 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Pyae Linn Aung ◽

Tepanata Pumpaibool ◽

Than Naing Soe ◽

Jessica Burgess ◽

Lynette J. Menezes ◽

...

Keyword(s):

Intervention Group ◽

Malaria Prevention ◽

Care Seeking ◽

Endemic Region ◽

Post Intervention ◽

Chi Square ◽

Transmission Season ◽

Baseline Knowledge ◽

Peak Transmission

Abstract Background Interventions to raise community awareness about malaria prevention and treatment have used various approaches with little evidence on their efficacy. This study aimed to determine the effectiveness of loudspeaker announcements regarding malaria care and prevention practices among people living in the malaria endemic villages of Banmauk Township, Sagaing Region, Myanmar. Methods Four villages among the most malaria-burdened areas were randomly selected: two villages were assigned as the intervention group, and two as the control. Prior to the peak transmission season of malaria in June 2018, a baseline questionnaire was administered to 270 participants from randomly selected households in the control and intervention villages. The loudspeaker announcements broadcasted health messages on malaria care and prevention practices regularly at 7:00 pm every other day. The same questionnaire was administered at 6-month post intervention to both groups. Descriptive statistics, Chi-square, and the t-test were utilized to assess differences between and within groups. Results Participants across the control and intervention groups showed similar socio-economic characteristics; the baseline knowledge, attitude and practice mean scores were not significantly different between the groups. Six months after the intervention, improvements in scores were observed at p-value < 0.001 in both groups, however; the increase was greater among the intervention group. The declining trend of malaria was also noticed during the study period. In addition, more than 75% of people expressed positive opinions of the intervention. Conclusions The loudspeaker intervention was found to be feasible and effective, as shown by the significant improvement in scores related to prevention and care-seeking practices for malaria as well as reduced malaria morbidity. Expanding the intervention to a larger population in this endemic region and evaluating its long-term effectiveness are essential in addition to replicating this in other low-resource malaria endemic regions.

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Effectiveness of a vancomycin dosing protocol guided by area under the concentration-time curve to minimal inhibitory concentration (AUC/MIC) with multidisciplinary team support to improve hospital-wide adherence to a vancomycin dosing protocol: A pilot study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.296 ◽

2021 ◽

pp. 1-6

Author(s):

Panipak Katawethiwong ◽

Anucha Apisarnthanarak ◽

Kittiya Jantarathaneewat ◽

David J. Weber ◽

David K. Warren ◽

...

Keyword(s):

Mortality Rate ◽

Multidisciplinary Team ◽

Kidney Injury ◽

University Hospital ◽

Routine Practice ◽

Post Intervention ◽

Coagulase Negative Staphylococci ◽

Time Curve ◽

Concentration Time ◽

Quasi Experimental

Abstract Background: Limited data are available on the implementation of an area under the concentration-time curve (AUC)–based dosing protocol with multidisciplinary team (MT) support to improve adherence with vancomycin dosing protocol. Objective: To evaluate the effectiveness of an AUC-based dosing protocol with MT support intervention with adherence to a hospital-wide vancomycin dosing protocol at Thammasat University Hospital. Method: We conducted a quasi-experimental study in patients who were prescribed intravenous vancomycin. The study was divided into 2 periods; (1) the preintervention period when the vancomycin dosing protocol was already applied in routine practice and (2) the post-intervention period when the implementation of an AUC-based dosing protocol with MT support was added to the existing vancomycin dosing protocol. The primary outcome was the rate of adherence, and the secondary outcomes included acute kidney injury events, vancomycin-related adverse events, and 30-day mortality rate. Results: In total, 240 patients were enrolled. The most common infections were skin and soft-tissue infections (24.6%) and bacteremia (24.6%). The most common pathogens were coagulase-negative staphylococci (19.6%) and Enterococcus spp (15.4%). Adherence with the vancomycin dosing protocol was significantly higher in the postintervention period (90.8% vs 55%; P ≤ .001). By multivariate analysis, an AUC-based dosing protocol with MT support was the sole predictor for adherence with the vancomycin dosing protocol (adjusted odds ratio, 10.31; 95% confidence interval, 4.54–23.45; P ≤ .001). The 30-day mortality rate was significantly lower during the postintervention period (8.3% vs 20%; P = .015). Conclusions: AUC-based dosing protocol with MT support significantly improved adherence with vancomycin dosing protocol and was associated with a lower 30-day mortality rate.

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