Systems Approach for Antibiotics in Colorectal Surgery in Growing Antimicrobial Resistance Background

Abstract

AIM: to reduce antibiotic resistance of infectious agents in colorectal surgery using optimal antibiotic therapy. PATIENTS AND METHODS: single-center interventional study with retrospective control has been done. Start point of intervention was January 2017, when it was provided direct administrative control of perioperative antibiotic prophylaxis protocols and empirical antibiotic therapy. The study included 200 patients after colorectal surgery in 2016-2017. Patients divided in two groups: in 2016 y – control (A), in 2017 – interventional one (B). RESULTS: significant decrease was detected in total antibiotic use from 16.1 to 12.2 defined daily dose (DDD) and in duration of antibiotic prophylaxis from 5.5 to 1.9 days (p<0.001). Incidence of infection caused by multi-resistant strains reduced from 84.3% to 50% (p<0.001). Analysis of etiology septic complications in colorectal patients showed a decrease in the number of Enterobacteriales, producing extended-spectrum beta-lactamases (ESBL) from 33.3% to 11.8% (р<0.01). The incidence of carbapenem-resistant Klostridium pneumoniae reduced from 7.8% до 0%, р=0.031. ESKAPE group pathogens decreased from 24 (47.1%) to 12 (17.7%), р<0.001. No difference in postoperative infectious morbidity between groups was detected (32.9% vs 31.0%, р=0.88). Incidence of antibiotic-associated diarrhea decreased from 5% to 0% (р=0.03). CONCLUSION: direct control of antibiotic prophylaxis protocols and empirical antibiotic therapy allowed to decrease the rate of antibiotic use and to decrease rate of infection complications caused by antibiotic resistance strains.