Abstract
Perioperative antibiotic use is a common reason for antibiotic misuse. Evidence suggests that adherence to SAP guidelines may improve outcomes. The purpose of this study was to analyze the impact of pharmacist-led antibiotic stewardship interventions on SAP guideline compliance. The study was conducted at an Orthopedic Department of a tertiary care medical center. SAP compliance and antibiotic exposure in the pre-intervention and intervention period was compared using chi-square, Fisher exact, and Mann-Whitney tests, as appropriate. Prophylactic antibiotic use in orthopedic joint arthroplasties (overall guideline adherence: agent, dose, frequency, duration), clinical outcomes (length of stay-LOS, number of surgical site infections-SSIs), antibiotic exposure and direct antibiotic costs were compared between pre-intervention and intervention periods. Significant improvement in mean SAP duration (by 42.9%, 4.08 ± 2.08 vs. 2.08 ± 1.90 days, p ˂ 0.001), and overall guideline adherence regarding antibiotic use (by 56.2%, from 2% to 58.2%, p ˂ 0.001) were observed. A significant decrease was observed in antibiotic exposure in SAP (by 41%, from 6.07 ± 0.05 to 3.58 ± 4.33 DDD/patient, p ˂ 0.001), average prophylactic antibiotic cost (by 54.8%, 9278.79 ± 6094.29 vs. 3598.16 ± 3354.55 HUF/patient), and mean LOS (by 37.2%, from 11.22 ± 6.96 to 7.62 ± 3.02 days, p < 0.001); and a slight decrease in the number of confirmed SSIs was found between the two periods (by 1.8%, from 3% to 1.2%, p = 0.21). Continuous presence of the clinical pharmacist led to significant improvement in SAP guideline adherence, which was accompanied by decreased antibiotic exposure and cost.
Highlights
Joint arthroplasties are frequently performed life-enhancing procedures
Pharmacist intervention can have a significant impact on SAP compliance in orthopedic surgical procedures, on the overall guideline adherence that may result in significant decrease in antibiotic exposure, cost, and clinical outcomes
We found that in the pre-intervention period irrational antibiotic use was quite frequent for SAP in orthopedic surgery
Summary
Joint arthroplasties are frequently performed life-enhancing procedures. The need for these surgical procedures continues to rise. Arthroplasties belong to clean surgical procedures [1,2], surgical site infections (SSIs) are not uncommon. SSIs are defined as infections occurring after arthroplasties, and can involve superficial or deep tissues at the operation site. PJI is Antibiotics 2021, 10, 1509 surgical procedures [1,2], surgical site infections (SSIs) are not uncommon. SSIs are defined as infections occurring after arthroplasties, and can involve superficial or dee2potfi1s2sues at the operation site. PJI is defined as infection involving the implants and adjacent tissues, which is one odfetfihneemd oasstinthferectaitoenniinngvoclovminpglitchaetiiomnpsliannotsrtahnodpaeddjiaccaerntthtriospsulaesst,iews,hbicehinigs orensepoofntshieblme ofosrt ethxcreeasstemnionrgbicdoimtypalincdatiinocnrseianseodrtchoosptsed[3ic,4a].rtShyrsotpemlasictieasn,tbibeainctgerrieaslppornospibhlyelafoxriseixscaessstamnodr-abriddiptyraacntdiceintcoreparseevdencotsStSs I[,3e,4s]p.eScyiasltleymwichaenrteibimacptelarinatlsparroepuhsyeladx[i5s,i6s].aIsntaadnedqaurdatperSauctrigceictaol AprnetvibeanctteSrSiIa,lePsrpoepchiaylllyaxwish(eSrAePim) cpalnanstigsnairfeicuasnetdly[i5n,6cr].eaInseadaenqtiubaiotetiScucrogniscuaml Apntitoibnaicntesruiar-l gPircoapl hwyalradxsis. BaacsisetdionnSiAnPterhnaaslteiodntaol satunduimesbethreoifnpvooslviteivmeeonut tocfotmhesp[h7a,1r0m,1a1c]i.stTiondSaAteP, hthaesrleedarteo naonpuumbbliesrhoefdproespiotirvtes foruotmcoHmuensg[7a,r1y0,r1e1g]a. rTdoindgatteh,ethreorle aorfepnhoaprmubacliisshtsedinreoppotirmtsizfrionmg aHnudnpgraormy oretignagrdriantigotnhael uroseleooffapnhtiabrimotaicsisitns iSnAoPp.timizing and promoting rational use of antibiotics in SAP
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