The Global Alliance for Infections in Surgery: Defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Massimo Sartelli, Francesco M. Labricciosa, Pamela Barbadoro, Leonardo Pagani, Luca Ansaloni, Adrian J. Brink, Jean Carlet, Ashish Khanna, Alain Chichom-Mefire, Federico Coccolini, Salomone Di Saverio, Addison K. May, Pierluigi Viale, Richard R. Watkins, Luigia Scudeller, Lilian M. Abbo, Fikri M. Abu-Zidan, Abdulrashid K. Adesunkanmi, Sara Al-Dahir, Majdi N. Al-HasanHalil Alis, Carlos Alves, André R. Araujo da Silva, Goran Augustin, Miklosh Bala, Philip S. Barie, Marcelo A. Beltrán, Aneel Bhangu, Belefquih Bouchra, Stephen M. Brecher, Miguel A. Caínzos, Adrian Camacho-Ortiz, Marco Catani, Sujith J. Chandy, Asri Che Jusoh, Jill R. Cherry-Bukowiec, Osvaldo Chiara, Elif Colak, Oliver A. Cornely, Yunfeng Cui, Zaza Demetrashvili, Belinda De Simone, Jan J. De Waele, Sameer Dhingra, Francesco Di Marzo, Agron Dogjani, Gereltuya Dorj, Laurent Dortet, Therese M. Duane, Mutasim M. Elmangory, Mushira A. Enani, Paula Ferrada, J. Esteban Foianini, Mahir Gachabayov, Chinmay Gandhi, Wagih Mommtaz Ghnnam, Helen Giamarellou, Georgios Gkiokas, Harumi Gomi, Tatjana Goranovic, Ewen A. Griffiths, Rosio I. Guerra Gronerth, Julio C. Haidamus Monteiro, Timothy C. Hardcastle, Andreas Hecker, Adrien M. Hodonou, Orestis Ioannidis, Arda Isik, Katia A. Iskandar, Hossein S. Kafil, Souha S. Kanj, Lewis J. Kaplan, Garima Kapoor, Aleksandar R. Karamarkovic, Jakub Kenig, Ivan Kerschaever, Faryal Khamis, Vladimir Khokha, Ronald Kiguba, Hong B. Kim, Wen Chien Ko, Kaoru Koike, Iryna Kozlovska, Anand Kumar, Leonel Lagunes, Rifat Latifi, Jae G. Lee, Young R. Lee, Ari Leppäniemi, Yousheng Li, Stephen Y. Liang, Warren Lowman, Gustavo M. Machain, Marc Maegele, Piotr Major, Sydney Malama, Ramiro Manzano-Nunez, Athanasios Marinis, Isidro Martinez Casas, Sanjay Marwah, Emilio Maseda, Michael E. McFarlane, Ziad Memish, Dominik Mertz, Cristian Mesina, Shyam K. Mishra, Ernest E. Moore, Akutu Munyika, Eleftherios Mylonakis, Lena Napolitano, Ionut Negoi, Milica D. Nestorovic, David P. Nicolau, Abdelkarim H. Omari, Carlos A. Ordonez, José Artur Paiva, Narayan D. Pant, Jose G. Parreira, Michal Pedziwiatr, Bruno M. Pereira, Alfredo Ponce-de-Leon, Garyphallia Poulakou, Jacobus Preller, Céline Pulcini, Guntars Pupelis, Martha Quiodettis, Timothy M. Rawson, Tarcisio Reis, Miran Rems, Sandro Rizoli, Jason Roberts, Nuno Rocha Pereira, Jesús Rodríguez-Baño, Boris Sakakushev, James Sanders, Natalia Santos, Norio Sato, Robert G. Sawyer, Sandro Scarpelini, Loredana Scoccia, Nusrat Shafiq, Vishalkumar Shelat, Costi D. Sifri, Boonying Siribumrungwong, Kjetil Søreide, Rodolfo Soto, Hamilton P. de Souza, Peep Talving, Ngo Tat Trung, Jeffrey M. Tessier, Mario Tumbarello, Jan Ulrych, Selman Uranues, Harry Van Goor, Andras Vereczkei, Florian Wagenlehner, Yonghong Xiao, Kuo Ching Yuan, Agnes Wechsler-Fördös, Jean Ralph Zahar, Tanya L. Zakrison, Brian Zuckerbraun, Wietse P. Zuidema, Fausto Catena

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Abstract

Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.

Original languageEnglish
Article number34
JournalWorld Journal of Emergency Surgery
Volume12
Issue number1
DOIs
Publication statusPublished - 2017 Aug 1

All Science Journal Classification (ASJC) codes

  • Surgery
  • Emergency Medicine

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    Sartelli, M., Labricciosa, F. M., Barbadoro, P., Pagani, L., Ansaloni, L., Brink, A. J., Carlet, J., Khanna, A., Chichom-Mefire, A., Coccolini, F., Di Saverio, S., May, A. K., Viale, P., Watkins, R. R., Scudeller, L., Abbo, L. M., Abu-Zidan, F. M., Adesunkanmi, A. K., Al-Dahir, S., ... Catena, F. (2017). The Global Alliance for Infections in Surgery: Defining a model for antimicrobial stewardship-results from an international cross-sectional survey. World Journal of Emergency Surgery, 12(1), [34]. https://doi.org/10.1186/s13017-017-0145-2