Surat Güzin, Vogel Ulrich, Wiegering Armin, Germer Christoph-Thomas, Lock Johan Friso
Department of Infection Control and Antimicrobial Stewardship, University Hospital of Würzburg, 97080 Würzburg, Germany.
Institute of Hygiene and Microbiology, University of Würzburg, 97080 Würzburg, Germany.
Antibiotics (Basel). 2021 Jan 14;10(1):73. doi: 10.3390/antibiotics10010073.
The aim of this study was to assess the impact of antimicrobial stewardship interventions on surgical antibiotic prescription behavior in the management of non-elective surgical intra-abdominal infections, focusing on postoperative antibiotic use, including the appropriateness of indications.
A single-center quality improvement study with retrospective evaluation of the impact of antimicrobial stewardship measures on optimizing antibacterial use in intra-abdominal infections requiring emergency surgery was performed. The study was conducted in a tertiary hospital in Germany from January 1, 2016, to January 30, 2020, three years after putting a set of antimicrobial stewardship standards into effect.
767 patients were analyzed ( = 495 in 2016 and 2017, the baseline period; = 272 in 2018, the antimicrobial stewardship period). The total days of therapy per 100 patient days declined from 47.0 to 42.2 days ( = 0.035). The rate of patients receiving postoperative therapy decreased from 56.8% to 45.2% ( = 0.002), comparing both periods. There was a significant decline in the rate of inappropriate indications (17.4% to 8.1 %, = 0.015) as well as a significant change from broad-spectrum to narrow-spectrum antibiotic use (28.8% to 6.5%, ≤ 0.001) for postoperative therapy. The significant decline in antibiotic use did not affect either clinical outcomes or the rate of postoperative wound complications.
Postoperative antibiotic use for intra-abdominal infections could be significantly reduced by antimicrobial stewardship interventions. The identification of inappropriate indications remains a key target for antimicrobial stewardship programs.
本研究旨在评估抗菌药物管理干预措施对非选择性外科腹腔内感染管理中手术抗生素处方行为的影响，重点关注术后抗生素使用情况，包括适应证的合理性。
开展一项单中心质量改进研究，对抗菌药物管理措施对优化急诊手术腹腔内感染抗菌药物使用的影响进行回顾性评估。该研究于2016年1月1日至2020年1月30日在德国一家三级医院进行，此时一套抗菌药物管理标准已实施三年。
共分析了767例患者（2016年和2017年为基线期，共495例；2018年为抗菌药物管理期，共272例）。每100个患者日的总治疗天数从47.0天降至42.2天（P = 0.035）。两个时期相比，接受术后治疗的患者比例从56.8%降至45.2%（P = 0.002）。术后治疗中不适当适应证的比例显著下降（从17.4%降至8.1%，P = 0.015），且术后治疗从使用广谱抗生素显著转变为使用窄谱抗生素（从28.8%降至6.5%，P≤0.001）。抗生素使用的显著下降并未影响临床结局或术后伤口并发症发生率。
抗菌药物管理干预措施可显著减少腹腔内感染的术后抗生素使用。识别不适当适应证仍是抗菌药物管理计划的关键目标。
