TY - JOUR
T1 - Reducing the duration of antibiotic therapy in surgical patients through a specific nationwide antimicrobial stewardship program. A prospective, interventional cohort study
AU - Batlle, Maria
AU - Badia, Josep M
AU - Hernández, S.
AU - Grau, Santiago
AU - Padulles, Ariadna
AU - Boix-Palop, Lucía
AU - Ferrer, Ricard
AU - Calbo Sebastián, Esther
AU - Limón, Enric
AU - Pujol, Miquel
AU - Horcajada, Juan Pablo
AU - Sabé, Núria
AU - Smithson, A.
AU - Ros, N.B.
AU - Gomila, Aina
AU - Pomar, Virginia
AU - Toboso, S.H.
AU - Murgadella-Sancho, A.
AU - Perez-Hita, A.O.
AU - Temple, M.d.
AU - Molpeceres, S.V.
AU - Rodríguez Pardo, Dolors
AU - del Río, Ana
AU - Solano Luque, Maria Fernanda
AU - Blanco, N.V.
AU - Acedo, Susana Otero
AU - Guitart, S.S.
AU - Nicolas, E.M.
AU - Noblia-Gigena, L.B.
AU - Pérez, O.d.R.
AU - Rodriguez, M.P.G.
AU - Barcons, I.A.
AU - Serra, N.J.
AU - Calva, L.C.
AU - Lérida, A.
AU - Torras, S.G.
AU - Martínez, L.H.
AU - Miñambres, C.
AU - Matellane, J.M.
AU - Jofre, C.S.
AU - Estada, S.B.
AU - Carrascosa, M.C.
AU - Mota, S.T.
AU - Barrena, D.S.
PY - 2023
Y1 - 2023
N2 - 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. 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. 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). 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.
AB - 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. 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. 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). 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.
KW - Anti-Bacterial Agents / therapeutic use
KW - Antimicrobial Stewardship / organization and administration
KW - Drug Resistance
KW - Multiple
KW - Bacterial / drug effects
KW - General Surgery / standards
KW - Infection Control / organization and administration
KW - Surgical Wound Infection / prevention and control
U2 - 10.1016/j.ijantimicag.2023.106943
DO - 10.1016/j.ijantimicag.2023.106943
M3 - Article
C2 - 37541529
SN - 0168-938X
VL - 62
JO - Antimicrobial Agents Annual
JF - Antimicrobial Agents Annual
IS - 5
ER -