7-VINCut Antibiotic Stewardship Intervention to Decrease Duration of Antibiotic Treatment and Carbapenem Use in Surgery

Summary

Antimicrobial resistance (AMR) is one of the top ten public health threats facing humanity. The misuse and overuse of antibiotics has been identified as a major factor in the development of drug-resistant pathogens, and 30% of all antimicrobials administered in Western acute hospitals are unnecessary or inappropriate. As a consequence, the establishment of antimicrobial stewardship programmes (ASPs) has increased in hospitals over the past decades.

Using ASPs to optimise antimicrobial use is critical to effectively fight infections, protect patients and reduce AMR. ASPs can increase infection cure rates while reducing AMR, but it has been reported that few of them are specifically targeted at surgical specialties or led by surgeons.

Surgeons are actively involved in antibiotic prescribing and should therefore play an important role in the development and leadership of ASPs in surgical departments.

Practice Guidelines have established recommendations for the wise use of antibiotics in patients affected by intra-abdominal infection: early identification of sepsis, early initiation of antimicrobial therapy and early control of the infectious focus. The literature on the optimal duration of antibiotic treatment in surgery is sparse, but it seems that, if the septic source has been effectively controlled, short courses of treatment show the same results as longer courses.Compliance rates with the suggested duration of treatment in evidence-based guidelines are low among the surgical community.

No specially designed ASPs for the reduction of treatment duration in surgery have been reported. ASPs may be easy to introduce in a single hospital, but the feasibility of a nationwide implementation of ASPs in a large and diverse hospital population is unclear.

This prospective, interventional, cohort study was aimed: to reduce the duration of antimicrobial treatment in surgical departments by modifying their prescriptions through educational and consensual interventions; and to assess the feasibility of implementing a multi-centre ASP, leveraging a nationwide surveillance programme for healthcare-associated infection.

It was hypothesised that a coordinated and guided implementation strategy, organised within a consolidated infection surveillance network, would lead to the successful implementation of the ASP and reduce antibiotic consumption in participating hospitals.

Conditions

• Medication Adherence
• Antibiotic Resistance, Microbial
• Medication Errors and Other Product Use Errors and Issues

Interventions

BEHAVIORAL

Antimicrobial stewardship in surgery

Hospitals were invited to form a surgical antibiotic stewardship program (ASP) with surgeons, pharmacists and infectious disease specialists. The interventional ASP relied on an audit and feedback strategy to issue recommendations aimed at reducing the duration of antibiotic treatment and the use of drugs with a particular impact on microbial ecology. All patients hospitalized in surgical departments were prospectively analyzed weekly. A computerized alert allowed the ASP team to identify patients with antibiotic treatment \>7 days. The team meet to discuss the appropriateness of each antibiotic treatment, issuing a written recommendation for each patient. The intervention was performed only once for each patient, except if they had a new focus of infection. The recommendations available for prolonged treatments were: withdraw, maintain, de-escalate, broaden, change route, optimize dose, no recommendation. Adherence to the recommendations was recorded 48 hours later by the ASP team.

Sponsors & Collaborators

• Hospital de Granollers

  lead OTHER

Principal Investigators

• Josep M Badia · Hospital General de Granollers

Study Design

Allocation

NA

Purpose

PREVENTION

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2019-01-01

Primary Completion

2021-12-31

Completion

2021-12-31

Countries

• Spain

Study Locations