Reducing the duration of antibiotic therapy in surgical patients through a specific nationwide antimicrobial stewardship program. A prospective, interventional cohort study
Author
Batlle, Maria
Badia, Josep M.
Hernández, Sergi
Grau, Santiago
Padulles, Ariadna
Boix-Palop, Lucía
Giménez-Pérez, Montserrat
Ferrer, Ricard
Calbo, Esther
Limón, Enric
Pujol, Miquel
Horcajada, Juan P.
Publication date
2023ISSN
0924-8579
Abstract
Background: 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. Methods: 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. Results: 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). Conclusions: 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.
Document Type
Article
Document version
Published version
Language
English
Subject (CDU)
61 - Medical sciences
Keywords
Agents antibacterians
Ús terapèutic
Organització i administració d'antimicrobians
Resistència a fàrmacs
Bacteris
Efectes de fàrmacs
Organització i administració d'infeccions
Cirurgia general
Prevenció i control
Agentes antibacterianos
Uso terapéutico
Organización y administración de antimicrobianos
Resistencia a fármacos
Bacterias
Efectos de fármacos
Organización y administración de infecciones
Cirugía general
Infección de heridas quirúrgicas
Infecció de ferides quirúrgiques
Prevención y control
Antibacterial agents
Therapeutic use
Organization and administration of antimicrobials
Drug resistance
Bacteria
Effects of drugs
Organization and administration of infections
General surgery
Surgical wound infection
Prevention and control
Pages
7
Publisher
Elsevier
Collection
62;5
Is part of
International Journal of Antimicrobial Agents
Citation
Batlle, Maria; Badia, Josep M.; Hernández, Sergi [et al.]. Reducing the duration of antibiotic therapy in surgical patients through a specific nationwide antimicrobial stewardship program. A prospective, interventional cohort study. International Journal of Antimicrobial Agents, 2023, 62(5), 106943. Disponible en: <https://www.sciencedirect.com/science/article/pii/S0924857923002224?via%3Dihub>. Fecha de acceso: 18 oct. 2023. DOI: 10.1016/j.ijantimicag.2023.106943
This item appears in the following Collection(s)
- Ciències de la Salut [725]
Rights
Under a Creative Commons license.
Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by-nc-nd/4.0/