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. 2020 Apr 9;9(4):168.
doi: 10.3390/antibiotics9040168.

Impact of Antimicrobial Stewardship Interventions on Appropriateness of Surgical Antibiotic Prophylaxis: How to Improve

Beatrice Tiri  1 , Paolo Bruzzone  2 , Giulia Priante  3 , Emanuela Sensi  4 , Monya Costantini  5 , Carlo Vernelli  3 , Lucia Assunta Martella  3 , Marsilio Francucci  6 , Paolo Andreani  7 , Alessandro Mariottini  7 , Andrea Capotorti  8 , Vito D'Andrea  9 , Daniela Francisci  10 , Roberto Cirocchi  11 , Stefano Cappanera  1
Affiliations

Impact of Antimicrobial Stewardship Interventions on Appropriateness of Surgical Antibiotic Prophylaxis: How to Improve

Beatrice Tiri et al. Antibiotics (Basel). .

Abstract

Surgical site infections (SSIs) are the most common healthcare-associated infections. The appropriate use of Surgical Antibiotic Prophylaxis (SAP) is a key component to reduce SSIs, while its inappropriate application is a major cause of some emerging infections and selects for antibiotic resistance. We describe an Antimicrobial Stewardship (AMS) intervention on SAP appropriateness. The prospective study was conducted in an Italian hospital, in 12 main surgical units, and was organized in three subsequent phases, as follows. Phase 0: Definition of hospital evidence-based guidelines and a new workflow to optimize the process of ordering, dispensing, administering and documenting the SAP. Phase 1: We analysed 2059 elective surgical cases from January to June 2018 for three SAP parameters of appropriateness: indication, choice and dose. Phase 2: In July 2018, an audit was performed to analyse the results; we reviewed 1781 elective surgical procedures from July to December 2018 looking for the same three SAP appropriateness parameters. The comparative analysis between phases 1 and 2 demonstrated that the correct indication, the correct dose and the overall compliance significantly improved (p-value 0.00128, p-value < 2.2·1016 and p-value < 5.6·1012 respectively). Our prospective study demonstrates a model of successful antimicrobial stewardship intervention that improves appropriateness on SAP.

Keywords: antibiotic resistance; antimicrobial stewardship; appropriateness; healthcare-associated infections; surgical antibiotic prophylaxis; surgical site infections.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Workflow of ordering, dispensing, administering and documenting, defined by Terni hospital evidence-based guidelines for the optimal use of SAP.
Figure 2
Figure 2
Overall compliance to SAP in phase 1 (January–June 2018) and phase 2 (July–December 2018).
See this image and copyright information in PMC

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