Antimicrobial Stewardship Programs Are Required in a Department of Surgery: "How" Is the Question A Quasi-Experimental Study: Results after Three Years

Surg Infect (Larchmt). 2020 Feb;21(1):35-42. doi: 10.1089/sur.2018.311. Epub 2019 Jul 26.

Abstract

Objective: Our aim was to describe our antimicrobial stewardship program and the methodology based on the results in a surgical department. Methods: Our study was a quasi-experimental study conducted from January 1, 2009, through September 30, 2017. The site was the General and Digestive Surgery Department in a public primary referral center, the University Hospital of Getafe (Madrid, Spain). We implemented the antimicrobial stewardship program following a prospective audit and feedback model, with a surgeon incorporated into the manaagement group. We studied the deaths and 30-day re-admission rates, length of stay, prevalence of gram-negative bacilli, meropenem resistance, and days of treatment with meropenem. Results: After three years of the program, we recorded a significant decrease in Pseudomonas aeruginosa prevalence, a significant increase in Klebsiella pneumoniae prevalence, a decrease in meropenem resistance, and a reduction in meropenem days of treatment. Conclusions: Antimicrobial stewardship programs have a desirable effect on patients. In our experience, the program team should be led by a staff from the particular department. When human resources are limited, the sustainability, efficiency, and effectiveness of interventions are feasible only with adequate computer support. Finally, but no less important, the necessary feedback between the prescribers and the team must be based on an ad hoc method such as that provided by statistical control charts, a median chart in our study.

Keywords: antimicrobial resistance; antimicrobial stewardship program; surgeons; surgery.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antimicrobial Stewardship* / methods
  • Antimicrobial Stewardship* / organization & administration
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control
  • Gram-Negative Bacterial Infections / epidemiology
  • Gram-Negative Bacterial Infections / prevention & control
  • Hospital Mortality
  • Hospitals, University / organization & administration
  • Hospitals, University / statistics & numerical data
  • Humans
  • Klebsiella Infections / epidemiology
  • Klebsiella Infections / prevention & control
  • Klebsiella pneumoniae
  • Length of Stay
  • Middle Aged
  • Patient Readmission / statistics & numerical data
  • Program Development
  • Pseudomonas Infections / epidemiology
  • Pseudomonas Infections / prevention & control
  • Spain
  • Surgery Department, Hospital* / organization & administration