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. 2025 Jul 19;20(1):63.
doi: 10.1186/s13017-025-00636-0.

Compliance with antimicrobial stewardship guidelines in surgery: an observational, multidisciplinary, cohort study

Salomé Goncalves  1 , Neyla Mohammedi  1 , François Antonini  1   2 , Alexandre Bleibtreu  3 , Marwan Bouras  4 , François Depret  5   6   7   8   9 , Pierre Fillatre  10   11 , Marc Garnier  12 , Rémy Gauzit  13 , Djamel Mokart  14 , Véronique Mondain  15 , Laurent Muller  16 , Bruno Pastene  1 , Mathilde Puges  17 , Philippe Amabile  18 , Cyrille Bastide  19 , Stéphane V Berdah  20 , Xavier B D'Journo  21 , Xavier Flecher  22   23 , Pierre-Hugues Roche  24 , Gabriel Birgand  25 , Carole Eldin  26   27 , Marc Leone  28   29   30
Affiliations

Compliance with antimicrobial stewardship guidelines in surgery: an observational, multidisciplinary, cohort study

Salomé Goncalves et al. World J Emerg Surg. .

Abstract

Purpose: Antimicrobial stewardship aims to improve clinical outcomes while reducing the unintended effects of antimicrobial use. The use of antibiotics in surgical wards, except for surgical antibiotic prophylaxis, has been poorly documented. Our goal was to assess the rate of compliance with the guidelines of antibiotic prescriptions in surgical wards.

Method: In a single academic center, a retrospective analysis was conducted over a two-month period to assess the rate of compliance with four criteria reflecting good practice in terms of antimicrobial stewardship: (1) decision of treatment initiation in line with the guidelines, (2) adequate spectrum of antibiotics in terms of patient characteristics; (3) duration of antibiotic treatment in compliance with the guidelines, and (4) whether re-adaptation of treatment was required. Positive responses to these four criteria indicated a 100% compliance rate. A pair of experts assessed the clinical vignettes to decide the compliance of each criterion. The secondary aims were to assess whether a 100% compliance rate was associated with positive outcomes.

Results: Among the 1,339 single stays in surgical wards, 232 patients (17%) received antibiotics during the study period. The rate of compliance with all four criteria was 33%. In addition, 149 (64%) patients complied with indication and spectrum, and 91 (39%) patients complied with indication, spectrum, and duration. Compliance with the antimicrobial treatment was associated with improved outcomes.

Conclusion: Of the patients hospitalized in the surgical wards, antimicrobial stewardship guidelines were complied with in 33% patients. Full compliance with the guidelines was associated with improved outcomes.

Supplementary Information: The online version contains supplementary material available at 10.1186/s13017-025-00636-0.

Keywords: Antibiotics; Compliance; Guidelines; Surgery.

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Conflict of interest statement

Declarations. Ethic statement: The study received approval from our ethics committee (CERAR IRB 00010254-2023-059) and was registered by our institution (APHM) under the number 2019-01 PADS23-123. The patients were informed about the study, and a non-opposition consent was obtained from each patient. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Rate of compliance according to the four criteria. The rate of compliance with indication, spectrum, duration and readaptation was represented by each bar
Fig. 2
Fig. 2
Factors associated with the composite criteria for outcome. An odds ratio below 1 was associated with improved outcomes
See this image and copyright information in PMC

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