Antimicrobial stewardship intervention for the clinical pathways improves antimicrobial prophylaxis in surgical or non‐surgical invasive therapies

Abstract

Summary Background The standard duration of administration of antimicrobial prophylaxis in surgery and non‐surgical invasive therapy was shortened according to the promotion of appropriate use. Here, we conducted an intervention to optimise antimicrobial prophylaxis by revising all relevant clinical pathways based on the most recent guidelines. Methods We conducted a single‐centre, prospective cohort study in patients who received antimicrobial prophylaxis to evaluate outcomes following revision of the clinical pathways for antimicrobial prophylaxis. Antibiotic consumption and the duration of antibiotic administration were compared before and after revising the clinical pathways. Results Thirty‐five of 171 clinical pathways were considered inappropriate for antimicrobial use and were optimised. After this revision, the duration of antibiotic administration was significantly shortened (before revision: 3 [1‐5] days vs after revision: 2 [1‐3] days, median [interquartile range], P < 0.001). The rate of discontinuation of antibiotics within 48 h after surgery or non‐surgical invasive therapy was significantly higher after the revision (62.4% vs 81.8%, P < 0.001). In contrast, the incidence of surgical site infection (SSI) was not significantly different before and after the revision (5.7% vs 4.3%, P = 0.177). A multivariate Cox proportional analysis indicated that revision of the clinical pathways was one of the prognostic factors associated with the discontinuation of antibiotics within 48 h after surgery or non‐surgical invasive therapy (hazard ratio, 0.69; 95% confidence interval, 0.63‐0.76, P < 0.001). Conclusions Our findings suggest that revising all relevant clinical pathways was highly effective in reducing antibiotic consumption and shortening the antibiotic administration period without increasing the incidence of SSIs.

Implementing an Antimicrobial Stewardship Programme to Improve Adherence to a Perioperative Prophylaxis Guideline

“…Similarly, optimising antibiotic prophylaxis resulted in an insignificant reduction in the overall SSI rate from 5.4% to 4.5% in another study [ 31 ]. Furthermore, Fujibayashi et al [ 32 ] have suggested that revising all relevant clinical pathways in invasive therapies may be highly effective in reducing antibiotic consumption and shortening the duration of antibiotic administration. It was found in the study conducted by Fujibayashi et al [ 32 ] that the incidence of SSIs was not significantly different before and after the revisions made.…”

A point prevalence survey study (PPS) of antimicrobial consumption in a tertiary care super-speciality hospital of West Bengal

“…Polymyxin use was relatively varied in some departments of the hospital and largely for the management of healthcare associated infections due to multidrug resistant organisms However, there is a need to strengthen infection control practices along with antimicrobial stewardship in order to bring down the use of these antimicrobials. 27 However, our survey was not without some limitations. Firstly, the data collection involved only 340 beds out of around 2100 beds in this hospital although it covered five departments.…”

Revised hospital antibiotic formulary reduces antimicrobial consumption and promotes a shift towards narrow‐spectrum antibiotic usage

“…Fujibayashi et al reported that revising clinical pathways effectively reduced antibiotic consumption and shortened the antibiotic administration period without increasing the incidence of surgical site infections. 10 Preauthorization and prospective audit and feedback [5][6][7][8][9]24,25 the usage of oral cephalosporins, macrolides and fluoroquinolones to the 50% target. In the future, it is thought that these combined efforts will be necessary at our hospital as well.…”

“…4 The Japanese government's AMR action plan aims to tackle this and set a target to "reduce the use of oral cephalosporins, quinolones, and macrolides per day per 1,000 inhabitants in 2020 by 50% from the level in 2013". 2 Previous reports have proposed preauthorization, [5][6][7] prospective audit and feedback [6][7][8][9] and revising clinical pathways 10 as methods to reduce antibiotic consumption. Most Japanese hospitals have pharmaceutical affairs committees that select and purchase pharmaceuticals based on the hospital's regulations.…”