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Perioperative antimicrobial prophylaxis in adult patients: The first multicenter clinical practice audit with intervention in Greek surgical departments

Published online by Cambridge University Press:  17 November 2020

Elisavet Chorafa
Affiliation:
Infectious Diseases Unit, Third Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
Elias Iosifidis
Affiliation:
Infectious Diseases Unit, Third Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
Sotirios Tsiodras
Affiliation:
Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
Athanasios Skoutelis
Affiliation:
Fifth Department of Medicine and Infectious Diseases Unit, Evangelismos General Hospital, Athens, Greece
Eleni Kourkouni
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Ioannis Kopsidas
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Grammatiki-Christina Tsopela
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Evangelia Chorianopoulou
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Christos Triantafyllou
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Georgia Kourlaba
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Theoklis Zaoutis
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Emmanuel Roilides*
Affiliation:
Infectious Diseases Unit, Third Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
*
Author for correspondence: Emmanuel Roilides, E-mail: roilides@med.auth.gr

Abstract

Objective:

To audit clinical practice and implement an intervention to promote appropriate use of perioperative antimicrobial prophylaxis (PAP).

Design:

Prospective multicenter before-and-after study.

Setting:

This study was conducted in 7 surgical departments of 3 major Greek hospitals.

Methods:

Active PAP surveillance in adults undergoing elective surgical procedures was performed before and after implementation of a multimodal intervention. The surveillance monitored use of appropriate antimicrobial agent according to international and local guidelines, appropriate timing and duration of PAP, overall compliance with all 3 parameters and the occurrence of surgical site infections (SSIs). The intervention included education, audit, and feedback.

Results:

Overall, 1,447 patients were included: 768 before and 679 after intervention. Overall compliance increased from 28.2% to 43.9% (P = .001). Use of antimicrobial agents compliant to international guidelines increased from 89.6% to 96.3% (P = .001). In 4 of 7 departments, compliance with appropriate timing was already >90%; an increase from 44.3% to 73% (P = .001) and from 20.4% to 60% (P = .001), respectively, was achieved in 2 other departments, whereas a decrease from 64.1% to 10.9% (P = .001) was observed in 1 department. All but one department achieved a shorter PAP duration, and most achieved duration of ~2 days. SSIs significantly decreased from 6.9% to 4% (P = .026). After the intervention, it was 2.3 times more likely for appropriate antimicrobial use, 14.7 times more likely to administer an antimicrobial for the appropriate duration and 5.3 times more likely to administer an overall appropriate PAP.

Conclusion:

An intervention based on education, audit, and feedback can significantly contribute to improvement of appropriate PAP administration; further improvement in duration is needed.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PHiG investigators: Polyxeni Karakosta MD, PhD, Sofia Kostourou RN, MSc, PhD, Sofia Kouni MSc, PhD, Christina Logotheti RN, MSc, Stefania Maistreli MSc, Nafsika-Maria Molocha MSc, Eleni Mylona MD, PhD and Fani Veini, RN, MSc, PhD.

References

European Centre for Disease Prevention and Control. Point prevalence survey of healthcare- associated infections and antimicrobial use in European acute-care hospitals. Stockholm: ECDC; 2013.Google Scholar
Plachouras, D, Karki, T, Hansen, S, et al. Antimicrobial use in European acute-care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017. Euro Surveill 2018;23.CrossRefGoogle Scholar
de Lissovoy, G, Fraeman, K, Hutchins, V, Murphy, D, Song, D, Vaughn, BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37:387397.CrossRefGoogle ScholarPubMed
Astagneau, P, Rioux, C, Golliot, F, Brucker, G, Group, INS. Morbidity and mortality associated with surgical site infections: results from the 1997–1999 INCISO surveillance. J Hosp Infect 2001;48:267274.CrossRefGoogle ScholarPubMed
European Centre for Disease Prevention and Control. Healthcare-associated infections: surgical site infections. In: ECDC. Annual Epidemiological Report for 2017. Stockholm: ECDC; 2019.Google Scholar
Cassini, A, Plachouras, D, Eckmanns, T, et al. Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study. PLoS Med 2016;13:e1002150.CrossRefGoogle ScholarPubMed
Anderson, DJ, Podgorny, K, Berrios-Torres, SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:605627.CrossRefGoogle ScholarPubMed
Bowater, RJ, Stirling, SA, Lilford, RJ. Is antibiotic prophylaxis in surgery a generally effective intervention? Testing a generic hypothesis over a set of meta-analyses. Ann Surg 2009;249:551556.CrossRefGoogle Scholar
Allegranzi, B, Bischoff, P, de Jonge, S, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016;16:e276e287.CrossRefGoogle ScholarPubMed
Page, CP, Bohnen, JM, Fletcher, JR, McManus, AT, Solomkin, JS, Wittmann, DH. Antimicrobial prophylaxis for surgical wounds: guidelines for clinical care. Arch Surg 1993;128:7988.CrossRefGoogle ScholarPubMed
Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97132.CrossRefGoogle ScholarPubMed
European Centre for Disease Prevention and Control. Systematic review and evidence-based guidance on perioperative antibiotic prophylaxis. Stockholm: ECDC; 2013.Google Scholar
Berrios-Torres, SI, Umscheid, CA, Bratzler, DW, et al. Centers for Disease Control And Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017;152:784791.CrossRefGoogle ScholarPubMed
Bratzler, DW, Dellinger, EP, Olsen, KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70:195283.CrossRefGoogle ScholarPubMed
Dellinger, EP, Gross, PA, Barrett, TL, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America. Clin Infect Dis 1994;18:422427.CrossRefGoogle ScholarPubMed
American Society of Health-System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 1999;56:18391888.CrossRefGoogle Scholar
Tourmousoglou, CE, Yiannakopoulou, E, Kalapothaki, V, Bramis, J, St Papadopoulos, J. Adherence to guidelines for antibiotic prophylaxis in general surgery: a critical appraisal. J Antimicrob Chemother 2008;61:214218.CrossRefGoogle ScholarPubMed
Miliani, K, L’Heriteau, F, Astagneau, P, Group, INS. Noncompliance with recommendations for the practice of antibiotic prophylaxis and risk of surgical site infection: results of a multilevel analysis from the INCISO Surveillance Network. J Antimicrob Chemother 2009;64:13071315.CrossRefGoogle ScholarPubMed
van Kasteren, ME, Kullberg, BJ, de Boer, AS, Mintjes-de Groot, J, Gyssens, IC. Adherence to local hospital guidelines for surgical antimicrobial prophylaxis: a multicentre audit in Dutch hospitals. J Antimicrob Chemother 2003;51:13891396.CrossRefGoogle ScholarPubMed
Dimopoulou, A, Papanikolaou, Z, Kourlaba, G, Kopsidas, I, Coffin, S, Zaoutis, T. Surgical site infections and compliance with perioperative antimicrobial prophylaxis in Greek children. Infect Control Hosp Epidemiol 2014;35:14251427.CrossRefGoogle ScholarPubMed
Bull, AL, Worth, LJ, Spelman, T, Richards, MJ. Antibiotic prescribing practices for prevention of surgical site infections in Australia: increased uptake of national guidelines after surveillance and reporting and impact on infection rates. Surg Infect (Larchmt) 2017;18:834840.CrossRefGoogle ScholarPubMed
Hohmann, C, Eickhoff, C, Radziwill, R, Schulz, M. Adherence to guidelines for antibiotic prophylaxis in surgery patients in German hospitals: a multicentre evaluation involving pharmacy interns. Infection 2012;40:131137.CrossRefGoogle Scholar
Parulekar, L, Soman, R, Singhal, T, Rodrigues, C, Dastur, FD, Mehta, A. How good is compliance with surgical antibiotic prophylaxis guidelines in a tertiary-care private hospital in India? A prospective study. Indian J Surg 2009;71:1518.CrossRefGoogle Scholar
Dona, D, Luise, D, La Pergola, E, et al. Effects of an antimicrobial stewardship intervention on perioperative antibiotic prophylaxis in pediatrics. Antimicrob Resist Infect Control 2019;8:13.CrossRefGoogle Scholar
Saied, T, Hafez, SF, Kandeel, A, et al. Antimicrobial stewardship to optimize the use of antimicrobials for surgical prophylaxis in Egypt: a multicenter pilot intervention study. Am J Infect Control 2015;43:e67e71.CrossRefGoogle ScholarPubMed
Murri, R, de Belvis, AG, Fantoni, M, et al. Impact of antibiotic stewardship on perioperative antimicrobial prophylaxis. Int J Qual Health Care 2016;28:502507.CrossRefGoogle ScholarPubMed
Bozkurt, F, Kaya, S, Gulsun, S, et al. Assessment of perioperative antimicrobial prophylaxis using ATC/DDD methodology. Int J Infect Dis 2013;17:e1212e1217.CrossRefGoogle ScholarPubMed
Ozgun, H, Ertugrul, BM, Soyder, A, Ozturk, B, Aydemir, M. Perioperative antibiotic prophylaxis: adherence to guidelines and effects of educational intervention. Int J Surg 2010;8:159163.CrossRefGoogle ScholarPubMed
van Kasteren, ME, Mannien, J, Kullberg, BJ, et al. Quality improvement of surgical prophylaxis in Dutch hospitals: evaluation of a multisite intervention by time series analysis. J Antimicrob Chemother 2005;56:10941102.CrossRefGoogle Scholar
Knox, MC, Edye, M. Educational Antimicrobial stewardship intervention ineffective in changing surgical prophylactic antibiotic prescribing. Surg Infect (Larchmt) 2016;17:224228.CrossRefGoogle ScholarPubMed
Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51e77.CrossRefGoogle Scholar
Versporten, A, Zarb, P, Caniaux, I, et al. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an Internet-based global point prevalence survey. Lancet Glob Health 2018;6:e619e629.CrossRefGoogle ScholarPubMed

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