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

Sartelli, Massimo and Labricciosa, Francesco M. and Barbadoro, Pamela and Pagani, Leonardo and Ansaloni, Luca and Brink, Adrian J. and Carlet, Jean and Khanna, Ashish and Chichom-Mefire, Alain and Coccolini, Federico and Di Saverio, Salomone and May, Addison K. and Viale, Pierluigi and Watkins, Richard R. and Scudeller, Luigia and Abbo, Lilian M. and Abu-Zidan, Fikri M. and Adesunkanmi, Abdulrashid K. and Al-Dahir, Sara and Al-Hasan, Majdi N. and Alis, Halil and Alves, Carlos and Araujo da Silva, André R. and Augustin, Goran and Bala, Miklosh and Barie, Philip S. and Beltrán, Marcelo A. and Bhangu, Aneel and Bouchra, Belefquih and Brecher, Stephen M. and Caínzos, Miguel A. and Camacho-Ortiz, Adrian and Catani, Marco and Chandy, Sujith J. and Jusoh, Asri Che and Cherry-Bukowiec, Jill R. and Chiara, Osvaldo and Colak, Elif and Cornely, Oliver A. and Cui, Yunfeng and Demetrashvili, Zaza and De Simone, Belinda and De Waele, Jan J. and Dhingra, Sameer and Di Marzo, Francesco and Dogjani, Agron and Dorj, Gereltuya and Dortet, Laurent and Duane, Therese M. and Elmangory, Mutasim M. and Enani, Mushira A. and Ferrada, Paula and Esteban Foianini, J. and Gachabayov, Mahir and Gandhi, Chinmay and Ghnnam, Wagih Mommtaz and Giamarellou, Helen and Gkiokas, Georgios and Gomi, Harumi and Goranović, Tatjana and Griffiths, Ewen A. and Guerra Gronerth, Rosio I. and Haidamus Monteiro, Julio C. and Hardcastle, Timothy C. and Hecker, Andreas and Hodonou, Adrien M. and Ioannidis, Orestis and Isik, Arda and Iskandar, Katia A. and Kafil, Hossein S. and Kanj, Souha S. and Kaplan, Lewis J. and Kapoor, Garima and Karamarkovic, Aleksandar R. and Kenig, Jakub and Kerschaever, Ivan and Khamis, Faryal and Khokha, Vladimir and Kiguba, Ronald and Kim, Hong B. and Ko, Wen-Chien and Koike, Kaoru and Kozlovska, Iryna and Kumar, Anand and Lagunes, Leonel and Latifi, Rifat and Lee, Jae G. and Lee, Young R. and Leppäniemi, Ari and Li, Yousheng and Liang, Stephen Y. and Lowman, Warren and Machain, Gustavo M. and Maegele, Marc and Major, Piotr and Malama, Sydney and Manzano-Nunez, Ramiro and Marinis, Athanasios and Martinez Casas, Isidro and Marwah, Sanjay and Maseda, Emilio and McFarlane, Michael E. and Memish, Ziad and Mertz, Dominik and Mesina, Cristian and Mishra, Shyam K. and Moore, Ernest E. and Munyika, Akutu and Mylonakis, Eleftherios and Napolitano, Lena and Negoi, Ionut and Nestorovic, Milica D. and Nicolau, David P. and Omari, Abdelkarim H. and Ordonez, Carlos A. and Paiva, José-Artur and Pant, Narayan D. and Parreira, Jose G. and Pędziwiatr, Michal and Pereira, Bruno M. and Ponce-de-Leon, Alfredo and Poulakou, Garyphallia and Preller, Jacobus and Pulcini, Céline and Pupelis, Guntars and Quiodettis, Martha and Rawson, Timothy M. and Reis, Tarcisio and Rems, Miran and Rizoli, Sandro and Roberts, Jason and Pereira, Nuno Rocha and Rodríguez-Baño, Jesús and Sakakushev, Boris and Sanders, James and Santos, Natalia and Sato, Norio and Sawyer, Robert G. and Scarpelini, Sandro and Scoccia, Loredana and Shafiq, Nusrat and Shelat, Vishalkumar and Sifri, Costi D. and Siribumrungwong, Boonying and Søreide, Kjetil and Soto, Rodolfo and de Souza, Hamilton P. and Talving, Peep and Trung, Ngo Tat and Tessier, Jeffrey M. and Tumbarello, Mario and Ulrych, Jan and Uranues, Selman and Van Goor, Harry and Vereczkei, Andras and Wagenlehner, Florian and Xiao, Yonghong and Yuan, Kuo-Ching and Wechsler-Fördös, Agnes and Zahar, Jean-Ralph and Zakrison, Tanya L. and Zuckerbraun, Brian and Zuidema, Wietse P. and Catena, Fausto (2017) The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey. World Journal of Emergency Surgery, 12. p. 34. ISSN 1749-7922

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Abstract

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.

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