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

2017; BioMed Central; Volume: 12; Issue: 1 Linguagem: Inglês

10.1186/s13017-017-0145-2

1749-7922

Massimo Sartelli, Francesco M. Labricciosa, Pamela Barbadoro, Léonardo Pagani, Luca Ansaloni, Adrian Brink, Jean Carlet, Ashish K. Khanna, Alain Chichom‐Mefire, Federico Coccolini, Salomone Di Saverio, Addison K. May, Pierluigi Viale, Richard R. Watkins, Luigia Scudeller, Lilian M. Abbo, Fikri M. Abu‐Zidan, A. R. K. Adesunkanmi, Sara Al-Dahir, Majdi N. Al‐Hasan, Halil Alış, Carlos Alves, André R. Araujo da Silva, Goran Augustin, Miklosh Bala, Philip S. Barie, Marcelo A. Beltrán, Aneel Bhangu, Bouchra Belefquih, Stephen M. Brecher, Miguel Caínzos, Adrián Camacho-Ortíz, Marco Catani, Sujith J Chandy, Asri Che Jusoh, Jill R. Cherry‐Bukowiec, Osvaldo Chiara, Elif Çolak, Oliver A. Cornely, Yunfeng Cui, Zaza Demetrashvili, Belinda De Simone, Jan J. De Waele, Sameer Dhingra, Francesco Di Marzo, Agron Dogjani, Gereltuya Dorj, Laurent Dortet, Therèse M. Duane, Mutasim M. Elmangory, Mushira Enani, Paula Ferrada, Esteban Foíanini, Mahir Gachabayov, Chinmay Gandhi, Wagih Ghnnam, Helen Giamarellou, Georgios Gkiokas, Harumi Gomi, Tatjana Goranović, Ewen A. Griffiths, Rosio Isabel Guerra Gronerth, Julio C. Haidamus Monteiro, Timothy Craig Hardcastle, Andreas Hecker, Adrien Montcho Hodonou, Orestis Ioannidis, Arda Işık, Katia Iskandar, Hossein Samadi Kafil, Souha S. Kanj, Lewis J. Kaplan, Garima Kapoor, Aleksandar Karamarković, Jakub Kenig, Ivan Kerschaever, Faryal Khamis, Vladimir Khokha, Ronald Kiguba, Hong Bin Kim, Wen‐Chien Ko, Kaoru Koike, I. M. Kozlovskа, Anand Kumar, Leonel Lagunes, Rifat Latifi, Jae Gil Lee, Young R. Lee, Ari Leppäniemi, Yousheng Li, Stephen Y. Liang, Warren Lowman, Gustavo M. Machaín, Marc Maegele, Piotr Major, Sydney Malama, Ramiro Manzano-Núñez, Athanasios Marinis, Isidro Martínez Casas, Sanjay Marwah, Emilio Maseda, Michael McFarlane, Ziad A. Memish, Dominik Mertz, Cristian Meşină, Shyam Kumar Mishra, Ernest E. Moore, Akutu Munyika, Eleftherios Mylonakis, Lena M. Napolitano, Ionuț Negoi, Milica Nestorović, David P. Nicolau, Abdelkarim H Omari, Carlos A. Ordóñez, José Artur Paiva, Narayan Dutt Pant, José Gustavo Parreira, Michał Pędziwiatr, Bruno M. Pereira, Alfredo Ponce‐de‐León, Garyphallia Poulakou, Jacobus Preller, Celiné Pulcini, G. Pupelis, Martha Quiodettis, Timothy M. Rawson, Tarcisio Reis, Miran Rems, Sandro Rizoli, Jason A. Roberts, Nuno Rocha Pereira, Jesús Rodríguez‐Baño, Boris Sakakushev, James M. Sanders, Natalia Trefilo Santos, Norio Sato, Robert G. Sawyer, Sandro Scarpelini, Loredana Scoccia, Nusrat Shafiq, Vishal G. Shelat, Costi D. Sifri, Boonying Siribumrungwong, Kjetil Søreide, Rodolfo Soto, Hamilton P. de Souza, Peep Talving, Ngo Tat Trung, Jeffrey M. Tessier, Mario Tumbarello, Jan Ulrych, Selman Uranues, Harry van Goor, András Vereczkei, Florian Wagenlehner, Yonghong Xiao, Kuo-Ching Yuan, Agnes Wechsler-Fördös, J.-R. Zahar, Tanya L. Zakrison, Brian S. Zuckerbraun, Wietse P. Zuidema, Fausto Catena,

Nosocomial Infections in ICU

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.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.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%).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.