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Reducing the duration of antibiotic therapy in surgical patients through a specific nationwide antimicrobial stewardship program. A prospective, interventional cohort study

2023; Elsevier BV; Volume: 62; Issue: 5 Linguagem: Inglês

10.1016/j.ijantimicag.2023.106943

1872-7913

Maria Batlle, Josep M. Badía, Sergi Hernández, Santiago Grau, Ariadna Padullés, Lucía Boix-Palop, Montserrat Giménez, Ricard Ferrer, Esther Calbo, Enrique Limón Cáceres, Miquel Pujol, Juan Pablo Horcajada, Núria Sabé, Marlene Álvarez Martins, Àlex Smithson, N. Bosacoma Ros, Aina Gomila‐Grange, Virginia Pomar, Sebastián Hernández Toboso, Anna Murgadella‐Sancho, Anna Oller Pérez-Hita, M. Temple, Sonia Vega Molpeceres, Dolors Rodríguez-Pardo, Ana del Rı́o, Maria Fernanda Solano Luque, Naiara Villalba Blanco, Susana Otero Acedo, Silvia Sancliment Guitart, Elisabeth Mauri Nicolas, Laura Beatriz Noblia-Gigena, Oscar del Río Pérez, Maria Placeres Garcia Rodriguez, I Aguilar Barcons, Natàlia Juan Serra, Luis Cajamarca Calva, Ana Lérida, Sara Garcia Torras, Lourdes Hernández Martínez, Carla Miñambres, Julen Montoya Matellane, Clara Sala Jofre, Sara Burgués Estada, Montserrat Carrascosa Carrascosa, Susana Torrecillas Mota, Daniel Serrano Barrena,

Bacterial Identification and Susceptibility Testing

Guidelines recommend 5-7 days of antibiotic treatment in patients with surgical infection and adequate source control. This nationwide stewardship intervention aimed to reduce the duration of treatments in surgical patients to 7 days were evaluated using a linear regression model and Pearson's correlation coefficients.A total of 32 499 patients were included. Of these, 13.7% had treatments ≥7 days. In all, 3912 stewardship interventions were performed, primarily in general surgery (90.7%) and urology (8.1%). The main types of infection were intra-abdominal (73.4%), skin/soft tissues (9.8%) and urinary (9.2%). The septic focus was considered controlled in 59.9% of cases. Out of 5458 antibiotic prescriptions, the most frequently analysed drugs were piperacillin/tazobactam (21.7%), metronidazole (11.2%), amoxicillin/clavulanate (10.3%), meropenem (10.7%), ceftriaxone (9.3%) and ciprofloxacin (6.7%). The main recommendations issued were: treatment discontinuation (35.0%), maintenance (40.0%) or de-escalation (15.5%), and the overall adherence rate was 91.5%. With adequate source control, the most frequent recommendation was to terminate treatment (51.2%). Throughout the study period, a significant decrease in the percentage of prolonged treatments was observed (Pc=-0.69;P < 0.001).This stewardship programme reduced the duration of treatments in surgical departments. Preference was given to general surgery services, intra-abdominal infection, and beta-lactam antibiotics, including carbapenems. Adherence to the issued recommendations was high.