Impact of antibiotic stewardship on perioperative antimicrobial prophylaxis.
OBJECTIVE
Antibiotic prophylaxis (AP) is useful to prevent antimicrobial overuse, misuse and abuse, as well against the occurrence of surgical site infections (SSIs). This study aimed to describe the implementation of a quality improvement intervention on AP for elective surgery, as informal interviews showed a lower than expected compliance with internal recommendations, and to evaluate intervention's effect in terms of main drug consumption.


METHODS
A quality improvement intervention on all elective cases within 14 main surgical departments was performed. SQUIRE 2.0 guidelines were used in designing and reporting.


METHODS
The intervention was implemented in an Italian Teaching Hospital 2 years after the adoption of internal evidence-based AP recommendations.


METHODS
Professionals involved in elective surgery.


METHODS
The intervention was structured into two phases: a survey was conducted during two non-consecutive weeks period (April-May 2013) to assess the adherence to the international guidelines in AP; survey's results were presented and discussed with all the surgical teams (December 2013-April 2014).


METHODS
Impact on cefazolin consumption (in defined daily doses per 100 procedures).


RESULTS
Data of AP for 653 surgical procedures in terms of type, timing, duration, excess and defect were analyzed. An optimal AP rate resulted in 48.1% cases. Reduction in cefazolin use (-21.5%) and cost (-22.9%) was registered.


CONCLUSIONS
Though results cannot be generalized to all hospital populations, the implemented intervention is likely to improve AP consequently improving quality of care and reducing costs. Further studies are needed to evaluate specific outcomes such as rate of SSIs and antibiotic resistance.
Teaching Hospital 'A. Gemelli', Largo Agostino Gemelli 1, 00168 Rome, Italy Department of Public Health, Infectious Disease Section, Catholic University 'Sacro Cuore', Largo Francesco Vito 1, 00168 Rome, Italy.
Rita
R
Murri
Teaching Hospital 'A. Gemelli', Largo Agostino Gemelli 1, 00168 Rome, Italy Department of Public Health, Hygiene Section, Catholic University 'Sacro Cuore', Largo Francesco Vito 1, 00168 Rome, Italy.
Antonio Giulio
AG
de Belvis
Teaching Hospital 'A. Gemelli', Largo Agostino Gemelli 1, 00168 Rome, Italy Department of Public Health, Infectious Disease Section, Catholic University 'Sacro Cuore', Largo Francesco Vito 1, 00168 Rome, Italy.
Massimo
M
Fantoni
Teaching Hospital 'A. Gemelli', Largo Agostino Gemelli 1, 00168 Rome, Italy Department of Public Health, Hygiene Section, Catholic University 'Sacro Cuore', Largo Francesco Vito 1, 00168 Rome, Italy.
Maria
M
Tanzariello
Department of Public Health, Hygiene Section, Catholic University 'Sacro Cuore', Largo Francesco Vito 1, 00168 Rome, Italy.
Paolo
P
Parente
Teaching Hospital 'A. Gemelli', Largo Agostino Gemelli 1, 00168 Rome, Italy Department of G.F. Ingrassia, Section of Hygiene and Public Health, University of Catania, Via Santa Sofia 87, 95123 Catania, Italy.
Stefano
S
Marventano
Teaching Hospital 'A. Gemelli', Largo Agostino Gemelli 1, 00168 Rome, Italy Department of Public Health, Hygiene Section, Catholic University 'Sacro Cuore', Largo Francesco Vito 1, 00168 Rome, Italy.
Sabina
S
Bucci
Teaching Hospital 'A. Gemelli', Largo Agostino Gemelli 1, 00168 Rome, Italy Department of Public Health, Infectious Disease Section, Catholic University 'Sacro Cuore', Largo Francesco Vito 1, 00168 Rome, Italy.
Francesca
F
Giovannenze
Teaching Hospital 'A. Gemelli', Largo Agostino Gemelli 1, 00168 Rome, Italy Department of Public Health, Hygiene Section, Catholic University 'Sacro Cuore', Largo Francesco Vito 1, 00168 Rome, Italy.
Walter
W
Ricciardi
Teaching Hospital 'A. Gemelli', Largo Agostino Gemelli 1, 00168 Rome, Italy Department of Public Health, Infectious Disease Section, Catholic University 'Sacro Cuore', Largo Francesco Vito 1, 00168 Rome, Italy.
Roberto
R
Cauda
Gabriele
G
Sganga
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D017558:Elective Surgical Procedures; D005260:Female; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents
antibiotic prophylaxis; excess/defect; quality improvement; surgical infection