Reducing the duration of antibiotic therapy in surgical patients through a specific nationwide antimicrobial stewardship program. A prospective, interventional cohort study
Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved..
BACKGROUND: Guidelines recommend 5-7 days of antibiotic treatment in patients with surgical infection and adequate source control. This nationwide stewardship intervention aimed to reduce the duration of treatments in surgical patients to <7 days.
METHODS: Prospective cohort study evaluating surgical patients receiving antibiotics ≥7 days in 32 hospitals. Indication for treatment, quality of source control, type of recommendations issued, and adherence to the recommendations were analysed. Temporal trends in the percentages of patients with treatment >7 days were evaluated using a linear regression model and Pearson's correlation coefficients.
RESULTS: A total of 32 499 patients were included. Of these, 13.7% had treatments ≥7 days. In all, 3912 stewardship interventions were performed, primarily in general surgery (90.7%) and urology (8.1%). The main types of infection were intra-abdominal (73.4%), skin/soft tissues (9.8%) and urinary (9.2%). The septic focus was considered controlled in 59.9% of cases. Out of 5458 antibiotic prescriptions, the most frequently analysed drugs were piperacillin/tazobactam (21.7%), metronidazole (11.2%), amoxicillin/clavulanate (10.3%), meropenem (10.7%), ceftriaxone (9.3%) and ciprofloxacin (6.7%). The main recommendations issued were: treatment discontinuation (35.0%), maintenance (40.0%) or de-escalation (15.5%), and the overall adherence rate was 91.5%. With adequate source control, the most frequent recommendation was to terminate treatment (51.2%). Throughout the study period, a significant decrease in the percentage of prolonged treatments was observed (Pc=-0.69;P < 0.001).
CONCLUSIONS: This stewardship programme reduced the duration of treatments in surgical departments. Preference was given to general surgery services, intra-abdominal infection, and beta-lactam antibiotics, including carbapenems. Adherence to the issued recommendations was high.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:62 |
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| Enthalten in: |
International journal of antimicrobial agents - 62(2023), 5 vom: 01. Nov., Seite 106943 |
| Sprache: |
Englisch |
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| Links: |
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| Anmerkungen: |
Date Completed 30.10.2023 Date Revised 30.10.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ijantimicag.2023.106943 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM360412203 |
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| 041 | |a eng | ||
| 100 | 1 | |a Batlle, Maria |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Reducing the duration of antibiotic therapy in surgical patients through a specific nationwide antimicrobial stewardship program. A prospective, interventional cohort study |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 30.10.2023 | ||
| 500 | |a Date Revised 30.10.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a BACKGROUND: Guidelines recommend 5-7 days of antibiotic treatment in patients with surgical infection and adequate source control. This nationwide stewardship intervention aimed to reduce the duration of treatments in surgical patients to <7 days | ||
| 520 | |a METHODS: Prospective cohort study evaluating surgical patients receiving antibiotics ≥7 days in 32 hospitals. Indication for treatment, quality of source control, type of recommendations issued, and adherence to the recommendations were analysed. Temporal trends in the percentages of patients with treatment >7 days were evaluated using a linear regression model and Pearson's correlation coefficients | ||
| 520 | |a RESULTS: A total of 32 499 patients were included. Of these, 13.7% had treatments ≥7 days. In all, 3912 stewardship interventions were performed, primarily in general surgery (90.7%) and urology (8.1%). The main types of infection were intra-abdominal (73.4%), skin/soft tissues (9.8%) and urinary (9.2%). The septic focus was considered controlled in 59.9% of cases. Out of 5458 antibiotic prescriptions, the most frequently analysed drugs were piperacillin/tazobactam (21.7%), metronidazole (11.2%), amoxicillin/clavulanate (10.3%), meropenem (10.7%), ceftriaxone (9.3%) and ciprofloxacin (6.7%). The main recommendations issued were: treatment discontinuation (35.0%), maintenance (40.0%) or de-escalation (15.5%), and the overall adherence rate was 91.5%. With adequate source control, the most frequent recommendation was to terminate treatment (51.2%). Throughout the study period, a significant decrease in the percentage of prolonged treatments was observed (Pc=-0.69;P < 0.001) | ||
| 520 | |a CONCLUSIONS: This stewardship programme reduced the duration of treatments in surgical departments. Preference was given to general surgery services, intra-abdominal infection, and beta-lactam antibiotics, including carbapenems. Adherence to the issued recommendations was high | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Anti-Bacterial Agents / therapeutic use | |
| 650 | 4 | |a Antimicrobial Stewardship / organization and administration | |
| 650 | 4 | |a Drug Resistance, Multiple, Bacterial / drug effects | |
| 650 | 4 | |a General Surgery / standards | |
| 650 | 4 | |a Infection Control / organization and administration | |
| 650 | 4 | |a Surgical Wound Infection / prevention and control | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 650 | 7 | |a Piperacillin, Tazobactam Drug Combination |2 NLM | |
| 650 | 7 | |a 157044-21-8 |2 NLM | |
| 700 | 1 | |a Badia, Josep M |e verfasserin |4 aut | |
| 700 | 1 | |a Hernández, Sergi |e verfasserin |4 aut | |
| 700 | 1 | |a Grau, Santiago |e verfasserin |4 aut | |
| 700 | 1 | |a Padulles, Ariadna |e verfasserin |4 aut | |
| 700 | 1 | |a Boix-Palop, Lucía |e verfasserin |4 aut | |
| 700 | 1 | |a Giménez-Pérez, Montserrat |e verfasserin |4 aut | |
| 700 | 1 | |a Ferrer, Ricard |e verfasserin |4 aut | |
| 700 | 1 | |a Calbo, Esther |e verfasserin |4 aut | |
| 700 | 1 | |a Limón, Enric |e verfasserin |4 aut | |
| 700 | 1 | |a Pujol, Miquel |e verfasserin |4 aut | |
| 700 | 1 | |a Horcajada, Juan P |e verfasserin |4 aut | |
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| 700 | 1 | |a Sabé, Núria |e investigator |4 oth | |
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| 700 | 1 | |a Toboso, Sebastián Hernández |e investigator |4 oth | |
| 700 | 1 | |a Murgadella-Sancho, Anna |e investigator |4 oth | |
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| 700 | 1 | |a Acedo, Susana Otero |e investigator |4 oth | |
| 700 | 1 | |a Guitart, Silvia Sancliment |e investigator |4 oth | |
| 700 | 1 | |a Nicolas, Elisabeth Mauri |e investigator |4 oth | |
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| 700 | 1 | |a Serra, Natàlia Juan |e investigator |4 oth | |
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| 700 | 1 | |a Miñambres, Carla |e investigator |4 oth | |
| 700 | 1 | |a Matellane, Julen Montoya |e investigator |4 oth | |
| 700 | 1 | |a Jofre, Clara Sala |e investigator |4 oth | |
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| 700 | 1 | |a Mota, Susana Torrecillas |e investigator |4 oth | |
| 700 | 1 | |a Barrena, Daniel Serrano |e investigator |4 oth | |
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