Laboratory of Therapeutic Chemistry and Pharmacognosy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium.
Department of Clinical Pharmacy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium.
Antimicrob Resist Infect Control. 2022 Jul 26;11(1):100. doi: 10.1186/s13756-022-01138-3.
An effective use of surgical antibiotic prophylaxis (SAP) appears essential to prevent the development of infections linked to surgery while inappropriate and excessive prescriptions of prophylactic antibiotics increase the risk of adverse effects, bacterial resistance and Clostridium difficile infections. In this study, we aimed to analyze SAP practices in an acute secondary hospital in Belgium during the years 2016-2021 in order to evaluate the impacts of combined stewardship interventions, implemented thanks to a physician-pharmacist collaboration.
A quasi-experimental study on SAP practices was conducted during 5 years (2016-2021) in a Belgian University Hospital. We first performed a retrospective observational transversal study on a baseline group (2016.1-2016.4). Then, we constituted a group of patients (2017.1-2017.4) to test a combined intervention strategy of stewardship which integrated the central role of a pharmacist in antibiotic stewardship team and in the pre-operative delivery of nominative kits of antibiotics adapted to patient factors. After this test, we collected patient data (2018.1-2018.4) to evaluate the sustained effects of stewardship interventions. Furthermore, we evaluated SAP practices (2019.1-2019.4) after the diffusion of a computerized decision support system. Finally, we analyzed SAP practices in the context of the COVID-19 pandemic (2020.1-2020.4 and 2021.1-2021.4). The groups were compared from year to year in terms of compliance to institutional guidelines, as evaluated from seven criteria (χ2 test).
In total, 760 surgical interventions were recorded. The observational study within the baseline group showed that true penicillin allergy, certain types of surgery and certain practitioners were associated with non-compliance (p < 0.05). Compared with the baseline group, the compliance was significantly increased in the test group for all seven criteria assessed (p < 0.05). However, the effects were not fully sustained after discontinuation of the active interventions. Following the diffusion of the computerized decision support system, the compliance to guidelines was not significantly improved. Finally, the COVID-19 pandemic did not appear to affect the practices in terms of compliance to guidelines.
This study shows that optimization of SAP practices is achievable within a proactive multidisciplinary approach including real-time pharmaceutical interventions in the operating area and in the care units practicing SAP.
有效使用外科抗生素预防用药（SAP）对于预防与手术相关的感染至关重要，而不适当和过度的预防性抗生素处方会增加不良反应、细菌耐药性和艰难梭菌感染的风险。在这项研究中，我们旨在分析 2016 年至 2021 年期间比利时一家急性二级医院的 SAP 实践情况，以评估通过医生-药剂师合作实施的综合管理干预措施的影响。
在一家比利时大学医院进行了为期 5 年（2016-2021 年）的 SAP 实践准实验研究。我们首先对基线组（2016.1-2016.4）进行了回顾性观察性横剖研究。然后，我们组成了一组患者（2017.1-2017.4），以测试一项综合管理策略，该策略整合了药剂师在抗生素管理团队中的核心作用，以及术前提供针对患者因素定制的抗生素套装。在这项测试之后，我们收集了患者数据（2018.1-2018.4），以评估管理干预的持续效果。此外，我们还评估了 SAP 实践（2019.1-2019.4）在计算机化决策支持系统传播后的情况。最后，我们分析了在 COVID-19 大流行背景下（2020.1-2020.4 和 2021.1-2021.4）的 SAP 实践情况。从七个标准（卡方检验）评估，从年度角度比较了各组对机构指南的遵守情况。
共记录了 760 例手术干预。在基线组内的观察性研究表明，真正的青霉素过敏、某些类型的手术和某些医生与不遵守规定有关（p<0.05）。与基线组相比，测试组在所有七个评估标准上的遵守率均显著提高（p<0.05）。然而，在停止主动干预后，效果并未完全持续。在计算机化决策支持系统传播后，指南的遵守情况并未显著改善。最后，COVID-19 大流行似乎并未影响指南遵守情况。
这项研究表明，通过包括在手术区和实施 SAP 的护理单元进行实时药学干预的主动多学科方法，可以优化 SAP 实践。
