Perioperative antimicrobial prophylaxis in adult patients: The first multicenter clinical practice audit with intervention in Greek surgical departments

Abstract

Objective: To audit clinical practice and implement an intervention to promote appropriate use of perioperative antimicrobial prophylaxis (PAP). Design: Prospective multicenter before-and-after study. Setting: This study was conducted in 7 surgical departments of 3 major Greek hospitals. Methods: Active PAP surveillance in adults undergoing elective surgical procedures was performed before and after implementation of a multimodal intervention. The surveillance monitored use of appropriate antimicrobial agent according to international and local guidelines, appropriate timing and duration of PAP, overall compliance with all 3 parameters and the occurrence of surgical site infections (SSIs). The intervention included education, audit, and feedback. Results: Overall, 1,447 patients were included: 768 before and 679 after intervention. Overall compliance increased from 28.2% to 43.9% (P = .001). Use of antimicrobial agents compliant to international guidelines increased from 89.6% to 96.3% (P = .001). In 4 of 7 departments, compliance with appropriate timing was already >90%; an increase from 44.3% to 73% (P = .001) and from 20.4% to 60% (P = .001), respectively, was achieved in 2 other departments, whereas a decrease from 64.1% to 10.9% (P = .001) was observed in 1 department. All but one department achieved a shorter PAP duration, and most achieved duration of ~2 days. SSIs significantly decreased from 6.9% to 4% (P = .026). After the intervention, it was 2.3 times more likely for appropriate antimicrobial use, 14.7 times more likely to administer an antimicrobial for the appropriate duration and 5.3 times more likely to administer an overall appropriate PAP. Conclusion: An intervention based on education, audit, and feedback can significantly contribute to improvement of appropriate PAP administration; further improvement in duration is needed.

Effect of an E-Prescription Intervention on the Adherence to Surgical Chemoprophylaxis Duration in Cardiac Surgery: A Single Centre Experience

“…These results cannot compare directly to our data, since we have studied cardiac operations only, which is the type of operation in which PAP is allowed for up to 48 h [8]. Chorafa et al recently published a study of a multimodal intervention in five hospitals in Greece, appropriate PAP duration increased from 33.4% to 60.3% [23]. In this study, cardiac surgery accounted for approximately 31% of the operations; however, the large discrepancy in improvement between that study and the current cannot be attributed to this only.…”

“…Attempts to improve adherence have been made in various centers and countries and been based on education and training, surveillance, and feedback, as well as in restrictive policies [19][20][21]. Data regarding adherence to PAP guidelines in Greece suggest that non-adherence is greater regarding PAP duration [22,23].…”

The impact of antimicrobial management by clinical pharmacists in obstetrics and gynecology on antimicrobial indicators, bacterial resistance and drug costs from 2011 to 2021 in China

“…AMS, such as audit, feedback, education, implementation of a protocol, and a computer-assisted decision support methodology, appear to be effective in promoting adherence to surgical antibiotic prophylaxis protocols, reducing surgical site infection rate with a positive economic impact [ 52 ]. Similar management techniques in China have also been successful in other countries and regions, such as in Nigeria [ 24 ], in Italy [ 53 ], in Britain [ 54 ], in Greece [ 55 ], in Australia [ 56 ], in South Africa [ 57 ], in Pakistan [ 58 ], in Spain [ 59 ], in Iran [ 60 ], in India [ 61 ], to name but a few.…”