The Effect of Pharmacist-Led Intervention on Surgical Antibacterial Prophylaxis (SAP) at an Orthopedic Unit
Abstract
:1. Introduction
2. Results
2.1. Patient’s Characteristics
2.2. SAP Characteristics and Pharmacist intervention
2.2.1. Agent Selection, Dosage
2.2.2. Timing and Duration of SAP
2.2.3. Antibiotic Exposure and Cost in SAP
2.2.4. Clinical Outcomes: LOS (Length of Stay) and SSIs
3. Discussion
3.1. Overall Guideline Adherence
3.2. Antibiotic Exposure and Cost
3.3. Clinical Outcomes
3.4. Limitations and Strengths of This Study
4. Materials and Methods
4.1. Study Design
4.2. Study Population
4.3. Exclusion Criteria
4.4. Pre-Intervention and Intervention Period
4.5. Data Collection
4.6. Data Analysis
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Parameters | Pre-Intervention Period N = 395 (%) | Intervention Period N = 182 (%) | p-Values |
---|---|---|---|
Age (Mean ± SD)—years | 65 ± 10.9 | 66 ± 10.5 | 0.292 |
18–65 | 174 (44.1%) | 75 (41.2%) | 0.685 |
65+ | 221 (55.9%) | 107 (58.8%) | 0.738 |
Gender | |||
Male | 151 (38.2%) | 70 (38.5%) | 0.971 |
Female | 244 (61.8%) | 112 (61.5%) | 0.979 |
Median body weight (range)-kg | 59.9 (35–105) | 62.1 (28–160) | 0.675 |
Diagnosis primary arthroplasty | |||
Osteoarthritis | 161 (40.8%) | 73 (40.1%) | 0.346 |
Osteonecrosis | 195 (49.4%) | 93 (51.1%) | 0.823 |
Others * | 16 (4%) | 6 (3.3%) | 0.671 |
Surgical procedure | |||
THA | 250 (63.3%) | 93 (51.1%) | 0.156 |
TKA | 122 (30.9%) | 79 (43.4%) | 0.044 |
Revision hip arthroplasty | 19 (4.8%) | 7 (3.8%) | 0.619 |
Revision knee arthroplasty | 4 (1%) | 3 (1.7%) | 0.522 |
Parameters | Pre-Intervention Period N = 395 (%) | Intervention Period N = 182 (%) | Increase/ Decrease % | p-Values |
---|---|---|---|---|
Number of antibiotics used simultaneously: 1 | 371 (93.9%) | 173 (95.1%) | 1.2% | 0.925 |
Number of antibiotics used simultaneously: 2–3 | 24 (6.1%) | 9 (4.9%) | −1.2% | 0.607 |
Guideline adherent antibiotic | 350 (88.6%) | 164 (90.1%) | 1.5% | 0.897 |
Cefuroxime | 348 (88.1%) | 160 (87.9%) | −0.2% | 0.987 |
Cefuroxime + amikacin | 2 (0.5%) | 4 (2.2%) | 1.7% | 0.066 |
Guideline non-adherent antibiotic | 45 (11.4%) | 18 (9.9%) | −1.5% | 0.629 |
Co-amoxiclav | 1 (0.3%) | - | −0.3% | 0.497 |
Ciprofloxacin | 22 (5.6%) | 13 (7.1%) | 1.5% | 0.490 |
beta-lactams or FQ + metronidazole | 20 (5%) | 4 (2.2%) | −2.8% | 0.122 |
beta-lactams or FQ + rifampin | 1 (0.3%) | - | −0.3% | 0.497 |
FQ + amikacin | 1 (0.3%) | 1 (0.6%) | 0.3% | 0.575 |
Guideline-adherent agent(s) | 350 (88.6%) | 164 (90.1%) | 1.5% | 0.897 |
Guideline-adherent agent, dosage | 341 (86.3%) | 162 (89%) | 2.7% | 0.815 |
Guideline-adherent agent, dosage, and duration | 8 (2%) | 106 (58.2%) | 56.2% | ˂0.001 |
Duration of prophylaxis—days (Mean ± SD/Median) | 4.08 ± 2.08 (3) | 2.42 ± 1.90 (1) | −42.9% | ˂0.001 |
One day prophylaxis | 9 (2.3%) | 113 (62.1%) | 59.8% | ˂0.001 |
Three days prophylaxis | 135 (34.2%) | 20 (11%) | −33.2% | ˂0.001 |
Over five days prophylaxis | 72 (18.2%) | 12 (6.6%) | −11.6% | ˂0.001 |
Guideline adherent duration | 20 (5%) | 117 (64.3%) | 59.3% | ˂0.001 |
Primary arthroplasties | 8 (2%) | 111 (61%) | 59% | ˂0.001 |
Revision arthroplasties | 12 (3%) | 6 (3.3%) | 0.3% | 0.872 |
DDD/patient (Mean ± SD) | 6.07 ± 0.05 | 3.58 ± 4.33 | −41% | ˂0.001 |
LOS—days (Mean ± SD/Median) | 11.22 ± 6.96 (9) | 7.62 ± 3.02 (7) | −37.2% | ˂0.001 |
SSIs onset—days (Mean ± SD/Median) | 8.91 ± 5.75 (8) | 8.5 ± 6.61 (8) | −3% | 0.170 |
Suspected SSIs | 43 (11.6%) | 4 (2.3%) | −9.3% | ˂0.001 |
Confirmed SSIs | 11 (3%) | 2 (1.2%) | −1.8% | 0.214 |
Need for postoperative antibiotic treatment due to SSIs | 77 (19.5%) | 5 (2.7%) | −16.8% | ˂0.001 |
Prophylactic antibiotic cost/patient—HUF (Mean ± SD) | 9278.79 ± 6094.29 | 3598.16 ± 3354.55 | −54.8% | ˂0.001 |
Primary Arthroplasties | 8768.70 ± 4478.91 | 3162.23 ± 2641.7 | −56.2% | ˂0.001 |
Revision Arthroplasties | 17,528.96 ± 15,852.28 | 9793.4 ± 6732.08 | −50.5% | 0.070 |
Active Agent | Dose (Adults) | Duration | |
---|---|---|---|
In Primary Arthroplasties | In Revision Arthroplasties | ||
cefazolin | 1–2 g iv q8h | up to 24 h | up to 5 days |
cefuroxime | 1.5 g/750 mg iv q8h | ||
clindamycin | 600/400 mg iv q8h | ||
vancomycin | 500 mg iv q6h | ||
1 gmg iv q12h | |||
amikacin | 15 mg/kg/day iv q8–12h | ||
gentamicin | 3–6 mg/kg/day iv q12–24h |
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Fésüs, A.; Benkő, R.; Matuz, M.; Kungler-Gorácz, O.; Fésüs, M.Á.; Bazsó, T.; Csernátony, Z.; Kardos, G. The Effect of Pharmacist-Led Intervention on Surgical Antibacterial Prophylaxis (SAP) at an Orthopedic Unit. Antibiotics 2021, 10, 1509. https://doi.org/10.3390/antibiotics10121509
Fésüs A, Benkő R, Matuz M, Kungler-Gorácz O, Fésüs MÁ, Bazsó T, Csernátony Z, Kardos G. The Effect of Pharmacist-Led Intervention on Surgical Antibacterial Prophylaxis (SAP) at an Orthopedic Unit. Antibiotics. 2021; 10(12):1509. https://doi.org/10.3390/antibiotics10121509
Chicago/Turabian StyleFésüs, Adina, Ria Benkő, Mária Matuz, Orsolya Kungler-Gorácz, Márton Á. Fésüs, Tamás Bazsó, Zoltán Csernátony, and Gábor Kardos. 2021. "The Effect of Pharmacist-Led Intervention on Surgical Antibacterial Prophylaxis (SAP) at an Orthopedic Unit" Antibiotics 10, no. 12: 1509. https://doi.org/10.3390/antibiotics10121509
APA StyleFésüs, A., Benkő, R., Matuz, M., Kungler-Gorácz, O., Fésüs, M. Á., Bazsó, T., Csernátony, Z., & Kardos, G. (2021). The Effect of Pharmacist-Led Intervention on Surgical Antibacterial Prophylaxis (SAP) at an Orthopedic Unit. Antibiotics, 10(12), 1509. https://doi.org/10.3390/antibiotics10121509