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. 2022 Apr 7:10:847420.
doi: 10.3389/fpubh.2022.847420. eCollection 2022.

Antimicrobial Stewardship in Surgery: A Literature Bibliometric Analysis

Yang-Xi Liu  1 , Ya Yang  2 , Ke-Jia Le  1 , Zai-Li Zhang  1 , Min Cui  1 , Han Zhong  1 , Zhi-Chun Gu  1
Affiliations

Antimicrobial Stewardship in Surgery: A Literature Bibliometric Analysis

Yang-Xi Liu et al. Front Public Health. .

Abstract

Background: Antimicrobial resistance and the dwindling antibiotic development pipeline have resulted in a looming post-antibiotic era. Research related to antimicrobial stewardship (AMS) has grown rapidly in the past decade, especially in the field of surgery. We conducted a bibliometric analysis of these publications. In addition, we aimed to identify research hotspots and infer future research trends.

Methods: We screened global publications on AMS in the surgical field over ten years (between 2011 and 2020) from the Web of Science core collection database. The keywords "antimicrobial or antibiotic", "stewardship", "management", "management strategies", "programme", "surgery" and "surgical" were used to search for related papers. VOS viewer, R software, and other machine learning and visualization tools were used to conduct the bibliometric analysis of the publications.

Results: We identified 674 publications on AMS in surgical fields; "antimicrobial stewardship" (with total link strength of 1,096) was the most frequent keyword, and had strong links to "antimicrobial resistance" and "guidelines". The top 100 most cited papers had a mean citation count of 47.21 (range: 17-1155) citations, which were cited by survey research studies, clinical trials, and observational studies. The highest-ranking and most cited journal was Clinical Infectious Diseases with eight publications. Jason G. Newland from Washington University wrote seven papers and was cited 1,282 times. The University of Washington published 17 papers and was cited 1,258 times, with the largest number of publications by author and organization. The USA published 198 papers and cooperated with 21 countries, mainly partnering with Italy, the UK, and Canada. Published articles mainly focused on the current clinical situation regarding surgical AMS management, antibiotic prescription, and antibiotic resistance.

Conclusions: Publications on surgical AMS management have increased in recent decades, with the USA being the most prolific. Epidemiological investigations of surgical-related infections, antibiotic prescriptions, and antibiotic resistance are fast-developing research trends. However, further improvements are still needed according to the recommendations gained from the bibliometric analysis.

Keywords: antimicrobial stewardship (AMS); bibliometric analysis; hospital management; surgery; trend.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of included publications. WoS, web of science.
Figure 2
Figure 2
Bibliometric analysis of authors and countries/regions. (A) Top 10 authors' productions over time. N. articles, Numbers of articles; TC per year, total citation per year. Among authors, Sartelli M was shortened of Massimo Sartelli, he was the author with the highest number of publications; Goossens H was shortened of Herman Goossens, he was most active author over time; Newland JG was shortened of Jason G. Newland, he was the most cited author. (B) Network of countries/regions cooperation. USA was the largest producer.
Figure 3
Figure 3
Bibliometric analysis of the keywords in publications of AMS in surgery. (A) Co-occurrence of keywords. Various nodes represent the frequency of different keywords occurrences. Curves between the nodes reveal their co-occurrence in the same publication. When the greater the number of co-occurrence in two keywords, the distance between two nodes are shorter. Among all keywords, “antimicrobial stewardship” linked with 718 other keywords (total link strength: 3,137) was the most frequency keywords. (B) Word cloud. 49 keywords which occurred more than 15 times were enrolled. Font size indicate the frequency of keywords occurrence. “Antimicrobial stewardship”, “antimicrobial resistance” occurred most frequently.
Figure 4
Figure 4
The top ten most active journals. (A) The top ten journals with most-cited publications of AMS in surgery; (B) The top ten journals with most published papers of AMS in surgery.
Figure 5
Figure 5
Bibliometric analysis of the citations. (A) The citations of authors. Two clusters with different colors were shown. Jason G Newland in green cluster was the most cited author (1,284 times). (B) The citations of organizations. J University of Washington in blue cluster (cited 1,258 times) has the largest number of published articles. (C) The citations of countries. Five clusters with different colors indicate were shown and USA in purple was cited most (cited 3,307 times). The size of circles indicates the counts of citations.
Figure 6
Figure 6
Bibliometric analysis of the bibliographic coupling and co-citation. (A) Bibliographic coupling map of documents, 8 cluster with different color represent the different study area and node indicate different articles included. The largest node was barlam (2016) with 1,109 citations and 55 total link strength in cluster 6; (B) co-citation map of sources, 4 cluster with different color represent source journals included in different study area. The largest cluster (cluster in red, 20 items) included the largest node (“clin infect dis” with 972 citations and 54 links with other source journals). In both figures, the size of the nodes indicates the counts of co-citations and the distance between two nodes represent their correlation.
Figure 7
Figure 7
Bibliometric analysis of themes. (A) Distribution map of the themes. Four clusters in green, bule, red and yellow were shown in the map, the nodes with same color represented a similar topic according to titles and abstracts. (B) Network map of the trend topics. The current publications in different color from purple to yellow. The size of the nodes demonstrates the frequency of appearance as the keywords and the distance between the two circles indicates their correlation.
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