Investigating infection management and antimicrobial stewardship in surgery: a qualitative study from India and South Africa

Singh, Sanjeev; Mendelson, Marc; Surendran, Surya; Bonaconsa, Candice; Mbamalu, Oluchi; Nampoothiri, Vrinda; Boutall, Adam; Hampton, Mark; Dhar, Puneet; Pennel, Timothy; Tarrant, Carolyn; Leather, Andrew J M; Holmes, Alison; Charani, Esmita; Ahmad, Raheelah; Castro‐Sánchez, Enrique; Birgand, Gabriel; Ndoli, Jules; Sassi, Franco; Sevdalis, Nick; Moonesinghe, Ramani; Lebcir, Reda; Ferlie, Ewan

doi:10.1016/j.cmi.2020.12.013

Cited by 30 publications

(34 citation statements)

References 27 publications

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“… 9 , 40 Learners also emphasize gaps in engagement between AMS teams and the healthcare teams they consult. Published literature confirms that AMS teams can work in isolation often with limited engagement with other specialties; 4 , 41 roles and expectations in AMS from the wider multidisciplinary team are unclear; 17 , 18 , 39 and lack of buy-in with respect to AMS may be exhibited by clinicians from other departments. 39 …”

Section: Discussionmentioning

confidence: 99%

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What does antimicrobial stewardship look like where you are? Global narratives from participants in a massive open online course

Nampoothiri

Bonaconsa

Surendran

et al. 2021

JAC-Antimicrobial Resistance

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Background Whilst antimicrobial stewardship (AMS) is being implemented globally, contextual differences exist. We describe how the use of a massive open online course (MOOC) platform provided an opportunity to gather diverse narratives on AMS from around the world. Methods A free 3 week MOOC titled ‘Tackling antimicrobial resistance: a social science approach’ was launched in November 2019. Learners were asked specific questions about their experiences of AMS via 38 optional free-text prompts dispersed throughout the modules. Content analysis was used to identify key emerging themes from the learners’ responses in the first three runs of the MOOC. Results Between November 2019 and July 2020, 1464 learners enrolled from 114 countries. Overall, 199 individual learners provided a total of 1097 responses to the prompts. The diverse perspectives describe unique challenges present in different contexts including ill-defined roles for pharmacists and nurses in AMS; inadequate governance and policy inconsistencies in surveillance for antibiotic consumption and antimicrobial resistance (AMR) in some countries; lack of ownership of antibiotic decision-making and buy-in from different clinical specialties; and human resource and technological constraints. Patients’ knowledge, experiences and perspectives were recognized as a valuable source of information that should be incorporated in AMS initiatives to overcome cultural barriers to the judicious use of antibiotics. Conclusions Analysis of learner comments and reflections identified a range of enablers and barriers to AMS implementation across different healthcare economies. Common challenges to AMS implementation included the role of non-physician healthcare workers, resource limitations, gaps in knowledge of AMR, and patient engagement and involvement in AMS.

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Section: Discussionmentioning

confidence: 99%

“… 27 , 42 Essentially, surveillance is a means to audit behaviour change. Effective, relevant and timely feedback of behaviours to measure change are recommended by Singh et al 18 as one of the components on a framework to improve integrated care in infection management.…”

Section: Discussionmentioning

confidence: 99%

What does antimicrobial stewardship look like where you are? Global narratives from participants in a massive open online course

Nampoothiri

Bonaconsa

Surendran

et al. 2021

JAC-Antimicrobial Resistance

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“… 81 , 82 The surgical specialty is often overlooked in AMS initiatives, and this is despite the high burden of infection in surgical populations, particularly in LMICs. 83 , 84 There must be much greater engagement with all healthcare professions, across specialties, with sustainable, agile training in AMS and IPC strategies. The Child Health Research Foundation in Bangladesh offers a model of capacity building to tackle AMR, 85 working with locally trained community healthcare workers who receive specific training not only in epidemiological data collection but also in recognition and referral of children with bacterial infectious diseases to qualified healthcare workers for diagnosis and treatment.…”

Section: Cross-cutting Systems Level Considerationsmentioning

confidence: 99%

Optimising antimicrobial use in humans – review of current evidence and an interdisciplinary consensus on key priorities for research

Charani

McKee

Ahmad

et al. 2021

The Lancet Regional Health - Europe

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Addressing the silent pandemic of antimicrobial resistance (AMR) is a focus of the 2021 G7 meeting. A major driver of AMR and poor clinical outcomes is suboptimal antimicrobial use. Current research in AMR is inequitably focused on new drug development. To achieve antimicrobial security we need to balance AMR research efforts between development of new agents and strategies to preserve the efficacy and maximise effectiveness of existing agents. Combining a review of current evidence and multistage engagement with diverse international stakeholders (including those in healthcare, public health, research, patient advocacy and policy) we identified research priorities for optimising antimicrobial use in humans across four broad themes: policy and strategic planning; medicines management and prescribing systems; technology to optimise prescribing; and context, culture and behaviours. Sustainable progress depends on: developing economic and contextually appropriate interventions; facilitating better use of data and prescribing systems across healthcare settings; supporting appropriate and scalable technological innovation. Implementing this strategy for AMR research on the optimisation of antimicrobial use in humans could contribute to equitable global health security.

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“…The issue of ownership of the antibiotic prescription or order is often not clear, particularly in surgical pathways where multiple healthcare professionals have a role to play. 155 The issue of ownership is also unclear when it comes to SAP, with surgeons and anaesthetists both identified as bearing the responsibility for the selection and administration of initial and any follow-up doses. 156 The issue of clinician autonomy taking precedence over policy and guidelines is an important factor, which can influence the selection of antibiotics and the duration of SAP.…”

Section: Optimising Current Practice Across Institutional Processesmentioning

confidence: 99%

Surgical Antibiotic Prophylaxis in an Era of Antibiotic Resistance: Common Resistant Bacteria and Wider Considerations for Practice

Menz¹,

Charani²,

Gordon³

et al. 2021

IDR

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The increasing incidence of antimicrobial resistance (AMR) presents a global crisis to healthcare, with longstanding antimicrobial agents becoming less effective at treating and preventing infection. In the surgical setting, antibiotic prophylaxis has long been established as routine standard of care to prevent surgical site infection (SSI), which remains one of the most common hospital-acquired infections. The growing incidence of AMR increases the risk of SSI complicated with resistant bacteria, resulting in poorer surgical outcomes (prolonged hospitalisation, extended durations of antibiotic therapy, higher rates of surgical revision and mortality). Despite these increasing challenges, more data are required on approaches at the institutional and patient level to optimise surgical antibiotic prophylaxis in the era of antibiotic resistance (AR). This review provides an overview of the common resistant bacteria encountered in the surgical setting and covers wider considerations for practice to optimise surgical antibiotic prophylaxis in the perioperative setting.

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Investigating infection management and antimicrobial stewardship in surgery: a qualitative study from India and South Africa

Cited by 30 publications

References 27 publications

What does antimicrobial stewardship look like where you are? Global narratives from participants in a massive open online course

What does antimicrobial stewardship look like where you are? Global narratives from participants in a massive open online course

Optimising antimicrobial use in humans – review of current evidence and an interdisciplinary consensus on key priorities for research

Surgical Antibiotic Prophylaxis in an Era of Antibiotic Resistance: Common Resistant Bacteria and Wider Considerations for Practice

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