title: Antimicrobial stewardship to optimize the use of antimicrobials for surgical prophylaxis in Egypt: A multicenter pilot intervention study.
abstract: OBJECTIVE
  To measure the impact of an antimicrobial stewardship (AMS) program on the use of antibiotics for surgical prophylaxis at acute care hospitals in Egypt.
  
  
  METHODS
  This was a before-and-after intervention study conducted in 5 tertiary, acute-care surgical hospitals. The baseline, intervention, and follow-up periods were 3, 6, and 3 months, respectively. The impact of the intervention was measured by preintervention and postintervention surveys for surgical patients with clean and clean-contaminated wounds. Information was collected on demographic characteristics and antibiotic use. The intervention focused mainly on educating surgical staff on the optimal timing and duration of antibiotics used for surgical prophylaxis. Only 3 hospitals identified a surgeon to audit antibiotic surgical prescriptions. The primary outcome measures were the percentages of surgical patients receiving optimal timing and duration of surgical prophylaxis.
  
  
  RESULTS
  Data were collected for 745 patients before the intervention and for 558 patients after the intervention. The optimal timing of the first dose improved significantly in 3 hospitals, increasing from 6.7% to 38.7% (P < .01), from 2.6% to 15.2% (P < .01), and from 0% to 11% (P < .01). All hospitals showed a significant rise in the optimal duration of surgical prophylaxis, with an overall increase of 3%-28% (P < .01). Days of therapy per 1000 patient-days were decreased significantly in hospitals A, B, C, and D, with no change in hospital E.
  
  
  CONCLUSIONS
  An AMS program focusing on education supported by auditing and feedback can have a significant impact on optimizing antibiotic use in surgical prophylaxis practices.
authors: Global Disease Detection and Response Program (GDDRP), US Naval Medical Research Unit No. 3, Cairo, Egypt. Electronic address: tamer.saeed.ctr.eg@med.navy.mil.
authors: Tamer
authors: T
authors: Saied
authors: Microbiology Department and Orthopedic Department, Alexandria University Hospitals, Alexandria, Egypt.
authors: Soad F
authors: SF
authors: Hafez
authors: Division of Preventive Medicine, Ministry of Health and Population, Cairo, Egypt.
authors: Amr
authors: A
authors: Kandeel
authors: Clinical Pathology Department, Cairo University Hospitals, Cairo, Egypt.
authors: Amany
authors: A
authors: El-kholy
authors: Clinical Pathology Department, Ain Shams University Hospitals, Cairo, Egypt.
authors: Ghada
authors: G
authors: Ismail
authors: Infection Control Unit and Obstetric and Gynecology Department, Zahraa University Hospital, Cairo, Egypt.
authors: Mariam
authors: M
authors: Aboushady
authors: Division of Preventive Medicine, Ministry of Health and Population, Cairo, Egypt.
authors: Ehab
authors: E
authors: Attia
authors: Microbiology Department and Orthopedic Department, Alexandria University Hospitals, Alexandria, Egypt.
authors: Ahmed
authors: A
authors: Hassaan
authors: Microbiology Department and Orthopedic Department, Alexandria University Hospitals, Alexandria, Egypt.
authors: Ossama
authors: O
authors: Abdel-Atty
authors: Clinical Pathology Department, Cairo University Hospitals, Cairo, Egypt.
authors: Elham
authors: E
authors: Elfekky
authors: Clinical Pathology Department, Ain Shams University Hospitals, Cairo, Egypt.
authors: Samia A
authors: SA
authors: Girgis
authors: Infection Control Unit and Obstetric and Gynecology Department, Zahraa University Hospital, Cairo, Egypt.
authors: Afaf
authors: A
authors: Ismail
authors: Global Disease Detection and Response Program (GDDRP), US Naval Medical Research Unit No. 3, Cairo, Egypt.
authors: Enjy
authors: E
authors: Abdou
authors: Global Disease Detection and Response Program (GDDRP), US Naval Medical Research Unit No. 3, Cairo, Egypt.
authors: Omar
authors: O
authors: Okasha
authors: Global Disease Detection and Response Program (GDDRP), US Naval Medical Research Unit No. 3, Cairo, Egypt.
authors: Maha
authors: M
authors: Talaat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000592:standards*; D004501:Education, Medical; D004534:Egypt; D005260:Female; D006291:Health Policy; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011300:Preoperative Care / Q000592:standards*; D013530:Surgical Wound Infection / Q000517:prevention & control; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: Antibiotic use; Egypt; Stewardship; Surgical prophylaxis