Antimicrobial stewardship to optimize the use of antimicrobials for surgical prophylaxis in Egypt: A multicenter pilot intervention study.
Am J Infect Control. 2015 Aug 25. pii: S0196-6553(15)00755-5.
Saied T1, Hafez SF2, Kandeel A3, El-Kholy A4, Ismail G5, Aboushady M6, Attia E3, Hassaan A2, Abdel-Atty O2, Elfekky E4, Girgis SA5, Ismail A6, Abdou E7, Okasha O7, Talaat M7.
1Global Disease Detection and Response Program (GDDRP), US Naval Medical Research Unit No. 3, Cairo, Egypt. Electronic address: email@example.com.
2Microbiology Department and Orthopedic Department, Alexandria University Hospitals, Alexandria, Egypt.
3Division of Preventive Medicine, Ministry of Health and Population, Cairo, Egypt.
4Clinical Pathology Department, Cairo University Hospitals, Cairo, Egypt.
5Clinical Pathology Department, Ain Shams University Hospitals, Cairo, Egypt.
6Infection Control Unit and Obstetric and Gynecology Department, Zahraa University Hospital, Cairo, Egypt.
7Global Disease Detection and Response Program (GDDRP), US Naval Medical Research Unit No. 3, Cairo, Egypt.
To measure the impact of an antimicrobial stewardship (AMS) program on the use of antibiotics for surgical prophylaxis at acute care hospitals in Egypt.
This was a before-and-after intervention study conducted in 5 tertiary, acute-care surgical hospitals. The baseline, intervention, and follow-up periods were 3, 6, and 3 months, respectively. The impact of the intervention was measured by preintervention and postintervention surveys for surgical patients with clean and clean-contaminated wounds. Information was collected on demographic characteristics and antibiotic use. The intervention focused mainly on educating surgical staff on the optimal timing and duration of antibiotics used for surgical prophylaxis. Only 3 hospitals identified a surgeon to audit antibiotic surgical prescriptions. The primary outcome measures were the percentages of surgical patients receiving optimal timing and duration of surgical prophylaxis.
Data were collected for 745 patients before the intervention and for 558 patients after the intervention. The optimal timing of the first dose improved significantly in 3 hospitals, increasing from 6.7% to 38.7% (P < .01), from 2.6% to 15.2% (P < .01), and from 0% to 11% (P < .01). All hospitals showed a significant rise in the optimal duration of surgical prophylaxis, with an overall increase of 3%-28% (P < .01). Days of therapy per 1000 patient-days were decreased significantly in hospitals A, B, C, and D, with no change in hospital E.
An AMS program focusing on education supported by auditing and feedback can have a significant impact on optimizing antibiotic use in surgical prophylaxis practices.