Cargando…

Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact

BACKGROUND: Antibiotic prophylaxis is one of the major approaches to prevent surgical site infection. Despite the availability of international guidelines on it, the practice of antibiotic prophylaxis is still far from optimal. This study aimed to assess the impact of guideline implementation on the...

Descripción completa

Detalles Bibliográficos
Autores principales: Mahmoudi, Laleh, Ghouchani, Mehrdad, Mahi-Birjand, Motahareh, Bananzadeh, Alimohammad, Akbari, Ali
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689569/
https://www.ncbi.nlm.nih.gov/pubmed/31496756
http://dx.doi.org/10.2147/IDR.S212728
_version_ 1783443045728911360
author Mahmoudi, Laleh
Ghouchani, Mehrdad
Mahi-Birjand, Motahareh
Bananzadeh, Alimohammad
Akbari, Ali
author_facet Mahmoudi, Laleh
Ghouchani, Mehrdad
Mahi-Birjand, Motahareh
Bananzadeh, Alimohammad
Akbari, Ali
author_sort Mahmoudi, Laleh
collection PubMed
description BACKGROUND: Antibiotic prophylaxis is one of the major approaches to prevent surgical site infection. Despite the availability of international guidelines on it, the practice of antibiotic prophylaxis is still far from optimal. This study aimed to assess the impact of guideline implementation on the rational use of prophylactic antibiotics and its cost-saving effect in gastrointestinal surgery by clinical pharmacist intervention. METHODS: A pre and post intervention study was carried out between October 2017 and June 2018 on patients who underwent gastrointestinal surgery in a major referral teaching hospital in Shiraz, southern Iran. The intervention phase consisted of revising the institutional guidelines for surgical antimicrobial prophylaxis, assigning a clinical pharmacist to the surgical department, and arranging several meetings with the surgical department regarding the appropriate utilization of antibiotics. Differences in antibiotic utilization in patients before and after the intervention phase were compared. Exposures were surgical antimicrobial prophylaxis timing and agents, and main outcomes were incidence of surgical site infection and length of hospital stay. RESULTS: A total of 430 patients were included in the post intervention phase, while 445 patients were included in the baseline evaluation. Promoting appropriate antibiotic use in the post intervention group had the potential to decrease medication costs by reducing unnecessary prescriptions and duration of antibiotic usage (P<0.001). In the pre intervention group, the mean cost of antibiotic prescriptions was 11.5 times that of the post intervention group. Mean hospitalization in the pre intervention group was greater than the post intervention group (P<0.001). Furthermore, our data revealed that the rate of postsurgery infection in the post intervention group was 3.03%, while this rate was 6.76% in the preintervention group (P=0.01). CONCLUSION: This study provides evidence that adherence to surgical antimicrobial prophylaxis guidelines increased the rational use of prophylactic antibiotics, with substantial cost savings in patients who underwent surgery.
format Online
Article
Text
id pubmed-6689569
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Dove
record_format MEDLINE/PubMed
spelling pubmed-66895692019-09-06 Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact Mahmoudi, Laleh Ghouchani, Mehrdad Mahi-Birjand, Motahareh Bananzadeh, Alimohammad Akbari, Ali Infect Drug Resist Original Research BACKGROUND: Antibiotic prophylaxis is one of the major approaches to prevent surgical site infection. Despite the availability of international guidelines on it, the practice of antibiotic prophylaxis is still far from optimal. This study aimed to assess the impact of guideline implementation on the rational use of prophylactic antibiotics and its cost-saving effect in gastrointestinal surgery by clinical pharmacist intervention. METHODS: A pre and post intervention study was carried out between October 2017 and June 2018 on patients who underwent gastrointestinal surgery in a major referral teaching hospital in Shiraz, southern Iran. The intervention phase consisted of revising the institutional guidelines for surgical antimicrobial prophylaxis, assigning a clinical pharmacist to the surgical department, and arranging several meetings with the surgical department regarding the appropriate utilization of antibiotics. Differences in antibiotic utilization in patients before and after the intervention phase were compared. Exposures were surgical antimicrobial prophylaxis timing and agents, and main outcomes were incidence of surgical site infection and length of hospital stay. RESULTS: A total of 430 patients were included in the post intervention phase, while 445 patients were included in the baseline evaluation. Promoting appropriate antibiotic use in the post intervention group had the potential to decrease medication costs by reducing unnecessary prescriptions and duration of antibiotic usage (P<0.001). In the pre intervention group, the mean cost of antibiotic prescriptions was 11.5 times that of the post intervention group. Mean hospitalization in the pre intervention group was greater than the post intervention group (P<0.001). Furthermore, our data revealed that the rate of postsurgery infection in the post intervention group was 3.03%, while this rate was 6.76% in the preintervention group (P=0.01). CONCLUSION: This study provides evidence that adherence to surgical antimicrobial prophylaxis guidelines increased the rational use of prophylactic antibiotics, with substantial cost savings in patients who underwent surgery. Dove 2019-08-06 /pmc/articles/PMC6689569/ /pubmed/31496756 http://dx.doi.org/10.2147/IDR.S212728 Text en © 2019 Mahmoudi et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Mahmoudi, Laleh
Ghouchani, Mehrdad
Mahi-Birjand, Motahareh
Bananzadeh, Alimohammad
Akbari, Ali
Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact
title Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact
title_full Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact
title_fullStr Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact
title_full_unstemmed Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact
title_short Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact
title_sort optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern iran: clinical and economic impact
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689569/
https://www.ncbi.nlm.nih.gov/pubmed/31496756
http://dx.doi.org/10.2147/IDR.S212728
work_keys_str_mv AT mahmoudilaleh optimizingcompliancewithsurgicalantimicrobialprophylaxisguidelinesinpatientsundergoinggastrointestinalsurgeryatareferralteachinghospitalinsoutherniranclinicalandeconomicimpact
AT ghouchanimehrdad optimizingcompliancewithsurgicalantimicrobialprophylaxisguidelinesinpatientsundergoinggastrointestinalsurgeryatareferralteachinghospitalinsoutherniranclinicalandeconomicimpact
AT mahibirjandmotahareh optimizingcompliancewithsurgicalantimicrobialprophylaxisguidelinesinpatientsundergoinggastrointestinalsurgeryatareferralteachinghospitalinsoutherniranclinicalandeconomicimpact
AT bananzadehalimohammad optimizingcompliancewithsurgicalantimicrobialprophylaxisguidelinesinpatientsundergoinggastrointestinalsurgeryatareferralteachinghospitalinsoutherniranclinicalandeconomicimpact
AT akbariali optimizingcompliancewithsurgicalantimicrobialprophylaxisguidelinesinpatientsundergoinggastrointestinalsurgeryatareferralteachinghospitalinsoutherniranclinicalandeconomicimpact