Abstract
There is paucity of data describing the effectiveness of antimicrobial stewardship in improving compliance with surgical antibiotic prophylaxis. This review evaluated the impact of antimicrobial stewardship interventions on compliance with surgical antibiotic prophylaxis measures, surgical site infection and economic outcome. PubMed, Scopus, Science Direct, and Google Scholar databases were searched to identify eligible studies that reported the impact of antimicrobial stewardship on compliance with surgical antibiotic prophylaxis and/or antibiotic utilization, surgical site infections from 2000 to 2017. Fourteen studies were selected; eight (57%) uncontrolled before-and-after studies, and two each randomized trial, interrupted time series and controlled before-and-after studies. Clinician education, organizational changes and audit and feedback were the most common stewardship interventions. Stewardship interventions improved compliance with antibiotic selection (1% - 90%); timing of first dose (5% - 96%); intra-operative re-dosing (28% - 53%); and total compliance (19% - 44%). Duration of antibiotic prophylaxis had the least improvement (7% - 25%) after stewardship interventions. Generally, studies with low baseline compliance rate showed greater improvements after stewardship interventions. Stewardship interventions reduced antibiotic utilization (20% - 35% Defined Daily Dose/100 procedures), surgical site infections (0.8% - 5.6%), and the costs of antibiotic prophylaxis per procedure ($ 2.5 - $ 345). Participation of stakeholders in antimicrobial stewardship program was vital for the success of the interventions. Low quality evidence shows that stewardship interventions improve compliance with surgical antibiotic prophylaxis measures, and reduced antibiotic utilization, surgical site infections and cost of surgical antibiotic prophylaxis.
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