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- Title
Antimicrobial stewardship intervention for the clinical pathways improves antimicrobial prophylaxis in surgical or non-surgical invasive therapies.
- Authors
Fujibayashi, Ayasa; Niwa, Takashi; Tsuchiya, Mayumi; Takeichi, Syuri; Suzuki, Keiko; Ohta, Hirotoshi; Yonetamari, Jun; Niwa, Ayumi; Yamamoto, Masayo; Hatakeyama, Daijiro; Baba, Hisashi; Suzuki, Akio; Murakami, Nobuo
- Abstract
<bold>Background: </bold>The standard duration of administration of antimicrobial prophylaxis in surgery and non-surgical invasive therapy was shortened according to the promotion of appropriate use. Here, we conducted an intervention to optimize antimicrobial prophylaxis by revising all relevant clinical pathways based on the most recent guidelines.<bold>Methods: </bold>We conducted a single-center, prospective cohort study in patients who received antimicrobial prophylaxis to evaluate outcomes following revision of the clinical pathways for antimicrobial prophylaxis. Antibiotic consumption and the duration of antibiotic administration were compared before and after revising the clinical pathways.<bold>Results: </bold>Thirty-five of 171 clinical pathways were considered inappropriate for antimicrobial use and were optimized. After this revision, the duration of antibiotic administration was significantly shortened (before revision: 3 [1-5] days vs after revision: 2 [1-3] days, median [interquartile range], P<0.001). The rate of discontinuation of antibiotics within 48 h after surgery or non-surgical invasive therapy was significantly higher after the revision (62.4% vs 79.2%, P<0.001). In contrast, the incidence of surgical site infection was not significantly different before and after the revision (5.8% vs 4.4%, P=0.177). A multivariate Cox proportional analysis indicated that revision of the clinical pathways was one of the prognostic factors associated with the discontinuation of antibiotics within 48 h after surgery or non-surgical invasive therapy (hazard ratio, 0.69; 95% confidence interval, 0.63-0.76, P<0.001).<bold>Conclusions: </bold>Our findings suggest that revising all relevant clinical pathways was highly effective in reducing antibiotic consumption and shortening the antibiotic administration period without increasing the incidence of surgical site infections. This article is protected by copyright. All rights reserved.
- Publication
International Journal of Clinical Practice, 2019, Vol 73, Issue 3, pN.PAG
- ISSN
1368-5031
- Publication type
journal article
- DOI
10.1111/ijcp.13293