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Článek

The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Sartelli, Massimo
Autor Sartelli, Massimo Department of Surgery, Macerata Hospital, Macerata, Italy
Labricciosa, Francesco M
Autor Labricciosa, Francesco M Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
Barbadoro, Pamela
Autor Barbadoro, Pamela Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
Pagani, Leonardo
Autor Pagani, Leonardo Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
Ansaloni, Luca
Autor Ansaloni, Luca General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
Brink, Adrian J
Autor Brink, Adrian J Department of Clinical microbiology, Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa. Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape town, South Africa
Carlet, Jean
Autor Carlet, Jean World Alliance against Antibiotics Resistance, Rome, Italy
Khanna, Ashish
Autor Khanna, Ashish Center for Critical Care, Anaesthesiology Institute and Department of Outcomes Research, Cleveland Clinic, Cleveland, OH USA
Chichom-Mefire, Alain
Autor Chichom-Mefire, Alain Department of Surgery and Obstetrics/Gynaecology, Regional Hospital, Limbe, Cameroon
Coccolini, Federico
Autor Coccolini, Federico Department of Surgery, Infermi Hospital, Rimini, Italy

World journal of emergency surgery. 2017 ; 12 (-) : 34. [pub] 20170801

World J Emerg Surg
ISSN 1749-7922
Medvik
Zdroj

BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. METHODS: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. RESULTS: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). CONCLUSION: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.