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Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery

Background—Appropriate perioperative antibiotic prophylaxis (PAP) is essential to prevent surgical site infections (SSIs) and to avoid antibiotics misuse. Aim—The aim of this study is to determine the effectiveness and long-term sustainability of an antimicrobial stewardship program (ASP), based on...

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Autores principales: Donà, Daniele, Luise, Dora, Barbieri, Elisa, Masiero, Nicola, Maita, Sonia, Antoniello, Luca, Zaoutis, Theoklis, Giaquinto, Carlo, Gamba, Piergiorgio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350339/
https://www.ncbi.nlm.nih.gov/pubmed/32575542
http://dx.doi.org/10.3390/pathogens9060490
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author Donà, Daniele
Luise, Dora
Barbieri, Elisa
Masiero, Nicola
Maita, Sonia
Antoniello, Luca
Zaoutis, Theoklis
Giaquinto, Carlo
Gamba, Piergiorgio
author_facet Donà, Daniele
Luise, Dora
Barbieri, Elisa
Masiero, Nicola
Maita, Sonia
Antoniello, Luca
Zaoutis, Theoklis
Giaquinto, Carlo
Gamba, Piergiorgio
author_sort Donà, Daniele
collection PubMed
description Background—Appropriate perioperative antibiotic prophylaxis (PAP) is essential to prevent surgical site infections (SSIs) and to avoid antibiotics misuse. Aim—The aim of this study is to determine the effectiveness and long-term sustainability of an antimicrobial stewardship program (ASP), based on a clinical pathway (CP) and periodic education, to improve adherence to the guidelines for PAP in a tertiary care pediatric surgery center. Methods—We assessed the changes in PAP correctness and its effect on SSIs between the six months before and the 24 months after the implementation of ASP in the Pediatric Surgery Unit of the Department of Women’s and Children’s Health of Padova. The ASP was addressed to all surgeons and anesthesiologists of the Pediatric Surgery Unit. The primary outcome was appropriateness of PAP (agent, timing of the first dose, and duration). SSI rate was the secondary outcome. Results—1771 patients were included in the study and 676 received PAP. The overall correctness of the PAP, in terms of agent, timing, and duration, increased significantly after the CP implementation. What changed most was the PAP discontinuation within 24 h (p < 0.001). Cefazolin was the most used antibiotic, with a significant increase in the post-intervention period (p < 0.001) and with a reduction in the use of other broad-spectrum antibiotics. No variations in the incidence of SSIs were reported in the five periods (p = 0.958). Conclusion—The implementation of an ASP based on CP and education is an effective and sustainable antimicrobial stewardship tool for improving the correct use of PAP.
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spelling pubmed-73503392020-07-15 Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery Donà, Daniele Luise, Dora Barbieri, Elisa Masiero, Nicola Maita, Sonia Antoniello, Luca Zaoutis, Theoklis Giaquinto, Carlo Gamba, Piergiorgio Pathogens Article Background—Appropriate perioperative antibiotic prophylaxis (PAP) is essential to prevent surgical site infections (SSIs) and to avoid antibiotics misuse. Aim—The aim of this study is to determine the effectiveness and long-term sustainability of an antimicrobial stewardship program (ASP), based on a clinical pathway (CP) and periodic education, to improve adherence to the guidelines for PAP in a tertiary care pediatric surgery center. Methods—We assessed the changes in PAP correctness and its effect on SSIs between the six months before and the 24 months after the implementation of ASP in the Pediatric Surgery Unit of the Department of Women’s and Children’s Health of Padova. The ASP was addressed to all surgeons and anesthesiologists of the Pediatric Surgery Unit. The primary outcome was appropriateness of PAP (agent, timing of the first dose, and duration). SSI rate was the secondary outcome. Results—1771 patients were included in the study and 676 received PAP. The overall correctness of the PAP, in terms of agent, timing, and duration, increased significantly after the CP implementation. What changed most was the PAP discontinuation within 24 h (p < 0.001). Cefazolin was the most used antibiotic, with a significant increase in the post-intervention period (p < 0.001) and with a reduction in the use of other broad-spectrum antibiotics. No variations in the incidence of SSIs were reported in the five periods (p = 0.958). Conclusion—The implementation of an ASP based on CP and education is an effective and sustainable antimicrobial stewardship tool for improving the correct use of PAP. MDPI 2020-06-19 /pmc/articles/PMC7350339/ /pubmed/32575542 http://dx.doi.org/10.3390/pathogens9060490 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Donà, Daniele
Luise, Dora
Barbieri, Elisa
Masiero, Nicola
Maita, Sonia
Antoniello, Luca
Zaoutis, Theoklis
Giaquinto, Carlo
Gamba, Piergiorgio
Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery
title Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery
title_full Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery
title_fullStr Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery
title_full_unstemmed Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery
title_short Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery
title_sort effectiveness and sustainability of an antimicrobial stewardship program for perioperative prophylaxis in pediatric surgery
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350339/
https://www.ncbi.nlm.nih.gov/pubmed/32575542
http://dx.doi.org/10.3390/pathogens9060490
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