Implementing an Antimicrobial Stewardship Programme to Improve Adherence to a Perioperative Prophylaxis Guideline
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting
2.2. Data Collection
2.3. Inclusion and Exclusion Criteria
2.4. Interventions
2.5. Data Analysis
3. Results
3.1. Patients’ Characteristics
3.2. Appropriateness of Antimicrobials Used for Prophylaxis
3.3. Reduction in SSI Rate
3.4. Antimicrobial Use
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Category | Number of Patients in the Pre-Intervention Phase n (%) | Number of Patients in the Post-Intervention Phase n (%) |
---|---|---|---|
Gender | Male | 85 (47.75) | 86 (46.74) |
Female | 93 (52.25) | 98 (53.26) | |
Age (years) | <10 | 8 (4.49) | 10 (5.43) |
10–19 | 29 (16.29) | 29 (15.76) | |
20–29 | 37 (20.79) | 39 (21.20) | |
30–39 | 48 (26.97) | 44 (23.92) | |
40–49 | 30 (16.86) | 38 (20.65) | |
50–59 | 19 (10.67) | 15 (8.15) | |
>59 | 7 (3.93) | 9 (4.89) |
Type of Surgery | Number of Surgeries in the Pre-Intervention Phase n (%) | Number of Surgeries in the Post-Intervention Phase n (%) |
---|---|---|
Appendectomy | 70 (39.33) | 79 (42.93) |
Bile duct/Gall bladder surgery | 82 (46.07) | 76 (41.31) |
Colorectal surgery | 26 (14.60) | 29 (15.76) |
Total | 178 | 184 |
Surgery Type | Use of Antibiotic | Pre-Intervention Phase n (%) | Post-Intervention Phase n (%) |
---|---|---|---|
Appendectomy | Yes | 68 (97.14) | 71 (89.87) |
No | 2 (2.86) | 8 (10.13) | |
Bile duct/Gallbladder surgery | Yes | 72 (87.80) | 68 (89.47) |
No | 10 (12.20) | 8 (10.53) | |
Colorectal surgery | Yes | 22 (84.62) | 25 (86.21) |
No | 4 (15.38) | 4 (13.79) | |
All gastrointestinal surgeries | Yes | 162 (91.01) | 164 (89.13) |
No | 16 (8.99) | 20 (10.87) |
Surgery Type | Appropriateness of Surgical Antimicrobial Prophylaxis | Pre-Intervention Phase n (%) | Post-Intervention Phase n (%) | p-Value | |
---|---|---|---|---|---|
Appendectomy | Selected drug(s) | Appropriate | 22 (32.35) | 29 (40.85) | 0.049 |
Inappropriate | 46 (67.65) | 42 (59.15) | |||
Drug dose(s) | Appropriate | 20 (29.41) | 29 (40.85) | ||
Inappropriate | 48 (70.59) | 42 (59.15) | |||
Timing | Appropriate | 44 (64.71) | 55 (77.46) | ||
Inappropriate | 24 (35.29) | 16 (22.54) | |||
Route of drug administration | Appropriate | 47 (69.12) | 57 (80.28) | ||
Inappropriate | 21 (30.88) | 14 (19.72) | |||
Duration | Appropriate | 2 (2.94) | 5 (7.04) | ||
Inappropriate | 66 (97.06) | 66 (92.96) | |||
Bile duct/Gall bladder surgery | Selected drug(s) | Appropriate | 55 (76.39) | 48 (70.59) | 0.461 |
Inappropriate | 17 (23.61) | 20 (29.41) | |||
Drug dose(s) | Appropriate | 24 (37.50) | 38 (55.88) | ||
Inappropriate | 48 (62.50) | 30 (44.12) | |||
Timing | Appropriate | 46 (63.89) | 45 (66.18) | ||
Inappropriate | 26 (36.11) | 23 (33.82) | |||
Route of drug administration | Appropriate | 46 (63.89) | 46 (67.65) | ||
Inappropriate | 26 (36.11) | 22 (32.35) | |||
Duration | Appropriate | 16 (22.22) | 21 (30.88) | ||
Inappropriate | 56 (77.78) | 47 (69.12) | |||
Colorectal surgery | Selected drug(s) | Appropriate | 6 (27.27) | 10 (40.00) | 0.0153 |
Inappropriate | 16 (72.73) | 15 (60.00) | |||
Drug dose(s) | Appropriate | 9 (40.91) | 21 (84.00) | ||
Inappropriate | 13 (50.09) | 4 (16.00) | |||
Timing | Appropriate | 15 (68.18) | 22 (88.00) | ||
Inappropriate | 7 (31.82) | 3 (12.00) | |||
Route of drug administration | Appropriate | 15 (68.18) | 23 (92.00) | ||
Inappropriate | 7 (31.82) | 2 (8.00) | |||
Duration | Appropriate | 5 (22.73) | 6 (24.00) | ||
Inappropriate | 17 (77.27) | 19 (76.00) | |||
Inappropriate | 139 (85.80) | 132 (80.49) |
Months | SSIs in 2019 (Pre-Intervention Period) | SSIs in 2020 (Post-Intervention Period) | ||
---|---|---|---|---|
Number of SSIs/Total Number of Surgeries | SSI Rate | Number of SSIs/Total Number of Surgeries | SSI Rate | |
January–March | 3/635 | 0.47% | 0/666 | 0.00% |
April–June | 2/639 | 0.31% | 0/469 | 0.00% |
July–September | 3/610 | 0.49% | 1/550 | 0.18% |
October–December | 3/811 | 0.37% | 0/706 | 0.00% |
Total | 11/2695 | 0.41% | 1/2391 | 0.04% |
Antibiotic | Route of Drug Administration | DDD of Antibiotic before the Intervention | DDD/100 Surgeries before the Intervention | DDD of Antibiotic after the Intervention | DDD/100 Surgeries after the Intervention |
---|---|---|---|---|---|
Ceftriaxone | Intravenous | 1.50 | 0.84 | 1 | 0.54 |
Cefuroxime | Intravenous | 24.5 | 13.76 | 0.50 | 0.27 |
Oral | 1414 | 794.38 | 994 | 540.22 | |
Metronidazole | Intravenous | 41.50 | 23.31 | 53.50 | 29.07 |
Oral | 71.4 | 40.11 | 63 | 34.24 | |
Ciprofloxacin | Intravenous | 2.25 | 1.26 | 0.25 | 0.14 |
Oral | 1 | 0.56 | 47.50 | 25.82 | |
Amoxicillin/Clavulanic acid | Oral | 62.12 | 34.90 | 232.53 | 126.38 |
Cefazolin | Intravenous | 0 | 0 | 14.67 | 7.97 |
Doxycycline | Oral | 0 | 0 | 42 | 22.83 |
Trimethoprim/Sulfamethoxazole | Oral | 0 | 0 | 2 | 1.09 |
Cefprozil | Oral | 20 | 11.24 | 0 | 0 |
Total | 1638.27 | 920.36 | 1450.95 | 788.56 |
Antibiotics | Route of Drug Administration | DDD/100 Surgeries before the Intervention | Antibiotic Cost in the Pre-Intervention Phase | DDD/100 Surgeries after the Intervention | Antibiotic Cost in the Post-Intervention Phase |
---|---|---|---|---|---|
Ceftriaxone | Intravenous | 0.84 | 77.28 | 0.54 | 49.68 |
Cefuroxime | Intravenous | 13.76 | 598.42 | 0.27 | 11.74 |
Oral | 794.38 | 6156.45 | 540.22 | 4186.71 | |
Metronidazole | Intravenous | 23.31 | 736.60 | 29.07 | 918.61 |
Oral | 40.11 | 768.11 | 34.24 | 655.70 | |
Ciprofloxacin | Intravenous | 1.26 | 199.95 | 0.14 | 22.22 |
Oral | 0.56 | 7.83 | 25.82 | 361.22 | |
Amoxicillin/Clavulanic acid | Oral | 34.90 | 244.30 | 126.38 | 884.66 |
Cefazolin | Intravenous | 0 | 0 | 7.97 | 89.26 |
Doxycycline | Oral | 0 | 0 | 22.83 | 531.94 |
Trimethoprim/Sulfamethoxazole | Oral | 0 | 0 | 1.09 | 18.37 |
Cefprozil | Oral | 11.24 | 724.98 | 0 | 0 |
Total | 920.36 | 9513.92 | 788.56 | 7730.11 |
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Ahmed, N.J.; Almalki, Z.S.; Alfaifi, A.A.; Alshehri, A.M.; Alahmari, A.K.; Elazab, E.; Almansour, A.; Haseeb, A.; Balaha, M.F.; Khan, A.H. Implementing an Antimicrobial Stewardship Programme to Improve Adherence to a Perioperative Prophylaxis Guideline. Healthcare 2022, 10, 464. https://doi.org/10.3390/healthcare10030464
Ahmed NJ, Almalki ZS, Alfaifi AA, Alshehri AM, Alahmari AK, Elazab E, Almansour A, Haseeb A, Balaha MF, Khan AH. Implementing an Antimicrobial Stewardship Programme to Improve Adherence to a Perioperative Prophylaxis Guideline. Healthcare. 2022; 10(3):464. https://doi.org/10.3390/healthcare10030464
Chicago/Turabian StyleAhmed, Nehad J., Ziyad S. Almalki, Abdullah A. Alfaifi, Ahmed M. Alshehri, Abdullah K. Alahmari, Emad Elazab, Alaa Almansour, Abdul Haseeb, Mohamed F. Balaha, and Amer H. Khan. 2022. "Implementing an Antimicrobial Stewardship Programme to Improve Adherence to a Perioperative Prophylaxis Guideline" Healthcare 10, no. 3: 464. https://doi.org/10.3390/healthcare10030464
APA StyleAhmed, N. J., Almalki, Z. S., Alfaifi, A. A., Alshehri, A. M., Alahmari, A. K., Elazab, E., Almansour, A., Haseeb, A., Balaha, M. F., & Khan, A. H. (2022). Implementing an Antimicrobial Stewardship Programme to Improve Adherence to a Perioperative Prophylaxis Guideline. Healthcare, 10(3), 464. https://doi.org/10.3390/healthcare10030464