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.
Highlights
Surgical site infections (SSIs) are the most common (20%) and costly of all hospital-acquired infections
The indication of antibiotic administration was in most cases appropriate, with a rate of 73.6%
The indication was inappropriate in 26.4% (543/2059) of cases as patients (98%) received a prophylactic antibiotic, and it was inappropriate if the American Society of Anaesthesiologists’
Summary
Surgical site infections (SSIs) are the most common (20%) and costly of all hospital-acquired infections They represent a major clinical problem in terms of mortality, morbidity, length of stay and overall costs. SSIs are a global priority because 20%–35% of them are caused by antibiotic-resistant strains [1,2]. The burden of infections in Europe is similar to the combined burden of three major infectious diseases (influenza, tuberculosis and HIV), and about 75% of the total burden of infections with antibiotic-resistant bacteria were associated with healthcare. The appropriate usage of Surgical Antibiotic Prophylaxis (SAP) significantly reduces the risk of SSI [4,5], while the inappropriate usage increases SSIs, hospital costs and multidrug-resistant strains [6,7,8,9,10,11]
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