Impact of the Antibiotic Stewardship Program on Prevention and Control of Surgical Site Infection during Peri-Operative Clean Surgery

Liu, Juyuan; Li, Na; Hao, Jinjuan; Liu, Yanming; Liu, Anlei; Wu, Yinghong; Cai, Meng

doi:10.1089/sur.2017.201

Cited by 14 publications

(14 citation statements)

References 31 publications

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“…La participación de los cirujanos pediatras en un programa racional de optimización de uso de los antibióticos, mejora la atención de los niños que consultan a los servicios de urgencias con una afección quirúrgica abdominal aguda 43,44 . Los cultivos rutinarios resultan ser de gran valor en la detección de los cambios epidemiológicos y de los patrones de resistencia a los antimicrobianos asociados con la peritonitis, lo que permite el ajuste subsecuente del tratamiento, según los patrones de sensibilidad y la evolución clínica.…”

Section: Discussionunclassified

Sensibilidad antimicrobiana en aislamientos de líquido peritoneal de niños intervenidos por abdomen agudo e infección intraabdominal

et al. 2019

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Introducción. La apendicitis aguda es causa frecuente de infección intraabdominal en pediatría. La elección del antibiótico se basa en los hallazgos quirúrgicos macroscópicos, el criterio médico, las guías locales o internacionales y, en pocas ocasiones, en el resultado de los aislamientos bacterianos en cultivos de líquido peritoneal y las tasas locales de resistencia. Se analizaron la frecuencia y la sensibilidad microbiológica de los cultivos de muestras de líquido peritoneal de pacientes de un mes a 16 años de edad con manejo quirúrgico por abdomen agudo con sospecha de infección intraabdominal. Materiales y métodos. Se llevó a cabo un estudio prospectivo de cohorte con análisis de las historias clínicas y de resultados de laboratorio de niños sometidos a cirugía por abdomen agudo, en la que el cirujano tomó muestra del líquido peritoneal para la tipificación y determinación de los perfiles de sensibilidad de los microorganismos aislados. Los datos se analizaron con el programa Stata™, versión15.0. Resultados. Se identificaron 303 casos, de los cuales el 93,6 % recibió profilaxis antibiótica con ampicilina-sulbactam y clindamicina-amikacina. El 95,3 % de los procedimientos fueron apendicectomías. Se tomó cultivo del 50 % de las apendicitis perforadas. Se aislaron 48 microorganismos; el más frecuente (2,7 %) fue Escherichia coli positiva para BLEE. El 100 % de los microorganismos resultaron ser sensibles a la amikacina, el 97,2 % al meropenem, y el 94,4 %, a la ciprofloxacina, el cefepime y el ceftazidime. La resistencia más frecuente (37,1 %) fue contra la combinación de ampicilina y sulbactam, en los gérmenes Gram negativos. Discusión. La evaluación de la sensibilidad antimicrobiana de los aislamientos de líquido peritoneal de los procedimientos quirúrgicos en pediatría, es una buena práctica clínica que orienta al cirujano en la adecuada selección del esquema antibiótico y, además, disminuye el riesgo de falla terapéutica temprana y la posibilidad de mayor resistencia o complicaciones infecciosas.

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Section: Discussionunclassified

Sensibilidad antimicrobiana en aislamientos de líquido peritoneal de niños intervenidos por abdomen agudo e infección intraabdominal

et al. 2019

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“…To investigate the effects of the antibiotic stewardship program on prevention and control of SSIs during clean surgery, Liu et al [ 13 ] compared the effect before and after an antibiotic stewardship program intervention. From January 1, 2010, to December 31, 2016, 41,426 patients underwent clean surgeries in a grade III, class A hospital.…”

Section: The Surgeon As a Champion In Preventing And Treating Infectimentioning

confidence: 99%

Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion

et al. 2018

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Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The “surgeon champion” can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.

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“…[2][3][4] Fortunately, 60% of SSIs are believed to be preventable with improved compliance to best practice guidelines, many of which hinge on perioperative antimicrobial administration. 1,5,6 For example, guidelines developed jointly by the Infectious Disease Society of America and Surgical Infection Society do not support antimicrobial prophylaxis for low-risk patients undergoing elective laparoscopic cholecystectomy, even in the setting of accidental gallbladder rupture. 7 Nevertheless, the duration of antimicrobial therapy for gallbladder disease varies widely due to a lack of high-quality evidence as well as surgeon preference.…”

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confidence: 99%

“…S urgical site infections (SSIs) are the most common health care-associated infection in surgical patients. 1 These infections have been shown to increase postoperative length of stay (LOS) by more than a week and are purported to account for nearly $10 billion annually in health care expenditures. [2][3][4] Fortunately, 60% of SSIs are believed to be preventable with improved compliance to best practice guidelines, many of which hinge on perioperative antimicrobial administration.…”

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confidence: 99%

The effect of prolonged antibiotics on postoperative complications for common bile duct stones: A post hoc analysis of an EAST multicenter study

Tracy

Paterson

Torres

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Antimicrobial guidance for common bile duct (CBD) stones is limited. We sought to examine the effect of antibiotic duration on infectious complications in patients with choledocholithiasis and/or gallstone pancreatitis. METHODS:We performed a post hoc analysis of a prospective, observational, multicenter study of patients undergoing same admission cholecystectomy for choledocholithiasis and gallstone pancreatitis between 2016 and 2019. We excluded patients with cholangitis and/ or cholecystitis. Patients were divided into groups based on duration of antibiotics: prophylactic (<24 hours) or prolonged (≥24 hours). We analyzed these two groups in the preoperative and postoperative periods. Outcomes included infectious complications, acute kidney injury (AKI), and hospital length of stay (LOS). RESULTS:There were 755 patients in the cohort. Increasing age, CBD diameter, and a preoperative endoscopic retrograde cholangiopancreatography (odds ratio, 1.91; 95% confidence interval, 1.34-2.73; p < 0.001) significantly predicted prolonged preoperative antibiotic use. Increasing age, operative duration, and a postoperative endoscopic retrograde cholangiopancreatography (odds ratio, 4.8; 95% confidence interval, 1.85-13.65; p < 0.001) significantly predicted prolonged postoperative antibiotic use. Rates of infectious complications were similar between groups, but LOS was 2 days longer for patients receiving overall prolonged antibiotics (p < 0.0001). Patients with AKI received two more days of overall antibiotic therapy (p = 0.02) compared with those without AKI. CONCLUSION:Rates of postoperative infectious complications were similar among patients treated with a prolonged or prophylactic course of antibiotics. Prolonged antibiotic use was associated with a longer LOS and AKI.

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Impact of the Antibiotic Stewardship Program on Prevention and Control of Surgical Site Infection during Peri-Operative Clean Surgery

Abstract: Long-term and continuous antibiotic stewardship programs have important effects on the prevention and control of SSI during clean surgery.

Cited by 14 publications

References 31 publications

Sensibilidad antimicrobiana en aislamientos de líquido peritoneal de niños intervenidos por abdomen agudo e infección intraabdominal

Sensibilidad antimicrobiana en aislamientos de líquido peritoneal de niños intervenidos por abdomen agudo e infección intraabdominal

Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion

The effect of prolonged antibiotics on postoperative complications for common bile duct stones: A post hoc analysis of an EAST multicenter study

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