Impact of an Institutional Antimicrobial Stewardship Program on Bacteriology of Surgical Site Infections in Cardiac Surgery

Ashfaq, Adeel; Zhu, Allen; Iyengar, Amit; Wu, Hoover; Humphries, Romney M.; McKinnell, James A.; Shemin, Richard J.; Benharash, Peyman

doi:10.1111/jocs.12756

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…Medication stewardship is well defined in the antimicrobial literature, and these concepts are spreading to a variety of medications and disease states, especially in treatments that are based heavily on expert consensus. 9,15,16 With the use of institution-specific clinical guidelines to standardize patient care in these scenarios, stewardship programs are then developed to ensure patient safety and guideline compliance. 17 However, providers have mixed opinions and attitudes when it comes to rationing care.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Immune Globulin Stewardship Program at a Tertiary Academic Medical Center

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Intravenous Immune Globulin Stewardship Program at a Tertiary Academic Medical Center

et al. 2016

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“…Medication stewardship is clearly established in the antimicrobial literature and similar ideas are now being applied to other therapies, particularly those that strongly rely on expert consensus [17–19]. In November 2021, the Saskatchewan IG Stewardship Program was initiated to ensure adherence to established consensus criteria, focusing on dosing regimens and indications for IVIG use.…”

Section: Discussionmentioning

confidence: 99%

Development, implementation and impact of an immunoglobulin stewardship programme in Saskatchewan, Canada

Sarker,

Vanstone,

Adigun

et al. 2024

Vox Sanguinis

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Background and ObjectivesIntravenous immunoglobulin (IVIG) is one of the most costly and limited‐supply blood products. Judicious use of this therapy is important to ensure a continued supply is available for patients in need. The Saskatchewan IG Stewardship Program was initiated to monitor and reduce inappropriate IG use.Materials and MethodsThe Program was developed and implemented through the collaborative efforts of a multidisciplinary, inter‐organizational team. Funding was provided from provincial organizations to create new positions within the Program and to support stakeholder engagement throughout the process of implementation. Data were collected from local and national databases regarding the amount of IVIG used and appropriateness of orders based on published criteria.ResultsOver 20 months, the Program helped to reduce unnecessary IVIG use from pre‐intervention levels by more than 20%. Interventions from nurse navigators alone reduced inappropriate IVIG use by 2.6%. During the 20‐month period following Program initiation, more than 4 million CAD less was spent on IVIG compared with the previous 20 months.ConclusionThe Saskatchewan IG Stewardship Program has led to more appropriate IVIG use across the province, more effective preservation of this limited healthcare resource, and cost savings that more than cover the cost of administering the Program.

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“…Antimicrobial stewardship (AMS), the primary goal of which is to optimise antimicrobial use, has been proven to be effective to improve surgical outcomes with increasing evidence. [11][12][13] However, as the idea becomes more widespread, implementing AMS remains a big challenge. Most of the AMS interventions require manual assessment and are best served by the expertise of infectious disease physicians or clinical pharmacists.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Open-label, single-centre, cluster-randomised controlled trial to Evaluate the Potential Impact of Computerisedantimicrobial stewardship (EPIC) on the antimicrobial use after cardiovascular surgeries: EPIC trial study original protocol

et al. 2020

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IntroductionInappropriate antimicrobial use increases the prevalence of antimicrobial-resistant bacteria. Surgeons are reluctant to implement recommendations of guidelines in clinical practice. Antimicrobial stewardship (AMS) is effective in antimicrobial management, but it remains labour intensive. The computerised decision support system (CDSS) has been identified as an effective way to enable key elements of AMS in clinical settings. However, insufficient evidence is available to evaluate the efficacy of computerised AMS in surgical settings.Methods and analysisThe Evaluate of the Potential Impact of Computerised AMS trial is an open-label, single-centre, two-arm, cluster-randomised, controlled trial, which aims to determine whether a multicomponent CDSS intervention reduces overall antimicrobial use after cardiovascular surgeries compared with usual clinical care in a specialty hospital with a big volume of cardiovascular surgeries. Eighteen cardiovascular surgical teams will be randomised 1:1 to either the intervention or the control arm. The intervention will consist of (1) re-evaluation alerts and decision support for the duration of antimicrobial treatment decision, (2) re-evaluation alerts and decision support for the choice of antimicrobial, (3) quality control audit and feedback. The primary outcome will be the overall systemic antimicrobial use measured in days of therapy (DOT) per admission and DOT per 1000 patient-days over the whole intervention period (6 months). Secondary outcomes include a series of indices to evaluate antimicrobial use, microbial resistance, perioperative infection outcomes, patient safety, resource consumption, and user compliance and satisfaction.Ethics and disseminationThe Ethics Committee in Fuwai Hospital approved this study (2020-1329). The results of the trial will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT04328090.

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Impact of an Institutional Antimicrobial Stewardship Program on Bacteriology of Surgical Site Infections in Cardiac Surgery

Abstract: Despite changes in antibiotic prophylaxis duration and postoperative skin treatment, our data demonstrate a stable incidence and composition of surgical wound infections during the study period. doi: 10.1111/jocs.12756 (J Card Surg 2016;31:367-372).

Cited by 5 publications

References 17 publications

Intravenous Immune Globulin Stewardship Program at a Tertiary Academic Medical Center

Intravenous Immune Globulin Stewardship Program at a Tertiary Academic Medical Center

Development, implementation and impact of an immunoglobulin stewardship programme in Saskatchewan, Canada

Open-label, single-centre, cluster-randomised controlled trial to Evaluate the Potential Impact of Computerisedantimicrobial stewardship (EPIC) on the antimicrobial use after cardiovascular surgeries: EPIC trial study original protocol

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