Abstract
Background: Antibiotic stewardship (AS) ward rounds are a core element in clinical care for surgical patients. Therefore, we aimed to analyze the impact of surgical AS ward rounds on antibiotic prescribing, and the sustainability of the effect after the AS interventions are no longer provided. Methods: On four wards of the department of visceral surgery, we conducted two independent retrospective prescribing analyses (P1, P2) over three months each. During the study periods, the level of AS intervention differed for two of the four wards (ward rounds/no ward rounds). Results: AS ward rounds were associated with a decrease in overall antibiotic consumption (91.1 days of therapy (DOT)/100 patient days (PD) (P1), 70.4 DOT/100PD (P2)), and improved de-escalation rates of antibiotic therapy (W1/2: 25.7% (P1), 40.0% (P2), p = 0.030; W3: 15.4 (P1), 24.2 (P2), p = 0.081). On the ward where AS measures were no longer provided, overall antibiotic usage remained stable (71.3 DOT/100PD (P1), 74.4 DOT/100PD (P2)), showing the sustainability of AS measures. However, the application of last-resort compounds increased from 6.4 DOT/100PD to 12.1 DOT/100PD (oxazolidinones) and from 10.8 DOT/100PD to 13.2 DOT/100PD (carbapenems). Conclusions: Antibiotic consumption can be reduced without negatively affecting patient outcomes. However, achieving lasting positive changes in antibiotic prescribing habits remains a challenge.
Highlights
Published: 11 December 2021Antibiotic resistance is a major global threat, making effective antibiotic treatment increasingly difficult, while the process of developing new antibiotics still has room for improvement [1]
To promote judicious anti-infective therapy, infectious disease societies are demanding the implementation of antimicrobial stewardship programs (ASPs), as infections caused by multidrug-resistant bacteria result in increased mortality, a prolonged hospital stay, and higher health care costs [8]
During P1, four patients were excluded from the study, due to incomplete sets of data and lengths of stay longer than 100 days, whereas nine patients were excluded in P2, due to incomplete sets of data and lengths of stay of over 100 days
Summary
Published: 11 December 2021Antibiotic resistance is a major global threat, making effective antibiotic treatment increasingly difficult, while the process of developing new antibiotics still has room for improvement [1]. In particular, last-resort compounds, such as oxazolidinones or carbapenems, is a serious concern worldwide, as antibiotic mis- and overuse in health care are known to be main drivers of antibiotic resistance [2,3]. To promote judicious anti-infective therapy, infectious disease societies are demanding the implementation of antimicrobial stewardship programs (ASPs), as infections caused by multidrug-resistant bacteria result in increased mortality, a prolonged hospital stay, and higher health care costs [8]. Intra-abdominal infections (IAI) are associated with high morbidity and mortality. Antibiotics, in addition to surgical source control, are indispensable in their treatment [9]. Most ASPs in surgery focus on the perioperative setting (i.e., antibiotic prophylaxis) and management of surgical site infections, and neglect pre- and postoperative antibiotic use [10]. Since Charani et al highlighted the importance of surgical ward rounds for Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations
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