Raising concerns about the Sepsis-3 definitions.
*Data Accuracy; *Infections; *Organ dysfunction; *Sepsis; *Septic shock; *Severity of Illness Index; Arterial Pressure; Consensus; Glasgow Coma Scale; Humans; Infection; Organ Dysfunction Scores; Publishing; Sensitivity and Specificity; Sepsis; Sepsis/*classification/mortality; Validation Studies
The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.
Sartelli Massimo; Kluger Yoram; Ansaloni Luca; Hardcastle Timothy C; Rello Jordi; Watkins Richard R; Bassetti Matteo; Giamarellou Eleni; Coccolini Federico; Abu-Zidan Fikri M; Adesunkanmi Abdulrashid K; Augustin Goran; Baiocchi Gian L; Bala Miklosh; Baraket Oussema; Beltran Marcelo A; Jusoh Asri Che; Demetrashvili Zaza; De Simone Belinda; de Souza Hamilton P; Cui Yunfeng; Davies R Justin; Dhingra Sameer; Diaz Jose J; Di Saverio Salomone; Dogjani Agron; Elmangory Mutasim M; Enani Mushira A; Ferrada Paula; Fraga Gustavo P; Frattima Sabrina; Ghnnam Wagih; Gomes Carlos A; Kanj Souha S; Karamarkovic Aleksandar; Kenig Jakub; Khamis Faryal; Khokha Vladimir; Koike Kaoru; Kok Kenneth Y Y; Isik Arda; Labricciosa Francesco M; Latifi Rifat; Lee Jae G; Litvin Andrey; Machain Gustavo M; Manzano-Nunez Ramiro; Major Piotr; Marwah Sanjay; McFarlane Michael; Memish Ziad A; Mesina Cristian; Moore Ernest E; Moore Frederick A; Naidoo Noel; Negoi Ionut; Ofori-Asenso Richard; Olaoye Iyiade; Ordonez Carlos A; Ouadii Mouaqit; Paolillo Ciro; Picetti Edoardo; Pintar Tadeja; Ponce-de-Leon Alfredo; Pupelis Guntars; Reis Tarcisio; Sakakushev Boris; Kafil Hossein Samadi; Sato Norio; Shah Jay N; Siribumrungwong Boonying; Talving Peep; Trana Cristian; Ulrych Jan; Yuan Kuo-Ching; Catena Fausto
World journal of emergency surgery : WJES
2018
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1186/s13017-018-0165-6" target="_blank" rel="noreferrer noopener">10.1186/s13017-018-0165-6</a>
The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey.
*Antibiotics; *Antimicrobial stewardship; *Infections; *Surgery; Academic Medical Centers; Anti-Infective Agents/*therapeutic use; Antibiotic Prophylaxis; Antiinfective Agents – Therapeutic Use; Antimicrobial Stewardship/*methods; Audit; Communicable Diseases; Community; Cross Sectional Studies; Cross-Sectional Studies; Culture; Data Analysis Software; Descriptive Statistics; Education; Female; Global Health/trends; Hospitals; Human; Humans; Infection – Prevention and Control; Infection Control – Methods; International Agencies; Intraabdominal Infections/*drug therapy; Male; Medical Organizations; Medical Practice; Microbiology; Multidisciplinary Care Team; Operative; Policy Making; Postoperative Complications/*drug therapy; Preoperative Care; Resource Allocation; Rural Areas; Specialization; Surgery; Surgical Wound Infection – Therapy; Surveys and Questionnaires; Urban Areas
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 \textless 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.
Sartelli Massimo; Labricciosa Francesco M; Barbadoro Pamela; Pagani Leonardo; Ansaloni Luca; Brink Adrian J; Carlet Jean; Khanna Ashish; Chichom-Mefire Alain; Coccolini Federico; Di Saverio Salomone; May Addison K; Viale Pierluigi; Watkins Richard R; Scudeller Luigia; Abbo Lilian M; Abu-Zidan Fikri M; Adesunkanmi Abdulrashid K; Al-Dahir Sara; Al-Hasan Majdi N; Alis Halil; Alves Carlos; Araujo da Silva Andre R; Augustin Goran; Bala Miklosh; Barie Philip S; Beltran Marcelo A; Bhangu Aneel; Bouchra Belefquih; Brecher Stephen M; Cainzos Miguel A; Camacho-Ortiz Adrian; Catani Marco; Chandy Sujith J; Jusoh Asri Che; Cherry-Bukowiec Jill R; Chiara Osvaldo; Colak Elif; Cornely Oliver A; Cui Yunfeng; Demetrashvili Zaza; De Simone Belinda; De Waele Jan J; Dhingra Sameer; Di Marzo Francesco; Dogjani Agron; Dorj Gereltuya; Dortet Laurent; Duane Therese M; Elmangory Mutasim M; Enani Mushira A; Ferrada Paula; Esteban Foianini J; Gachabayov Mahir; Gandhi Chinmay; Ghnnam Wagih Mommtaz; Giamarellou Helen; Gkiokas Georgios; Gomi Harumi; Goranovic Tatjana; Griffiths Ewen A; Guerra Gronerth Rosio I; Haidamus Monteiro Julio C; Hardcastle Timothy C; Hecker Andreas; Hodonou Adrien M; Ioannidis Orestis; Isik Arda; Iskandar Katia A; Kafil Hossein S; Kanj Souha S; Kaplan Lewis J; Kapoor Garima; Karamarkovic Aleksandar R; Kenig Jakub; Kerschaever Ivan; Khamis Faryal; Khokha Vladimir; Kiguba Ronald; Kim Hong B; Ko Wen-Chien; Koike Kaoru; Kozlovska Iryna; Kumar Anand; Lagunes Leonel; Latifi Rifat; Lee Jae G; Lee Young R; Leppaniemi Ari; Li Yousheng; Liang Stephen Y; Lowman Warren; Machain Gustavo M; Maegele Marc; Major Piotr; Malama Sydney; Manzano-Nunez Ramiro; Marinis Athanasios; Martinez Casas Isidro; Marwah Sanjay; Maseda Emilio; McFarlane Michael E; Memish Ziad; Mertz Dominik; Mesina Cristian; Mishra Shyam K; Moore Ernest E; Munyika Akutu; Mylonakis Eleftherios; Napolitano Lena; Negoi Ionut; Nestorovic Milica D; Nicolau David P; Omari AbdelKarim H; Ordonez Carlos A; Paiva Jose-Artur; Pant Narayan D; Parreira Jose G; Pedziwiatr Michal; Pereira Bruno M; Ponce-de-Leon Alfredo; Poulakou Garyphallia; Preller Jacobus; Pulcini Celine; Pupelis Guntars; Quiodettis Martha; Rawson Timothy M; Reis Tarcisio; Rems Miran; Rizoli Sandro; Roberts Jason; Pereira Nuno Rocha; Rodriguez-Bano Jesus; Sakakushev Boris; Sanders James; Santos Natalia; Sato Norio; Sawyer Robert G; Scarpelini Sandro; Scoccia Loredana; Shafiq Nusrat; Shelat Vishalkumar; Sifri Costi D; Siribumrungwong Boonying; Soreide Kjetil; Soto Rodolfo; de Souza Hamilton P; Talving Peep; Trung Ngo Tat; Tessier Jeffrey M; Tumbarello Mario; Ulrych Jan; Uranues Selman; van Goor Harry; Vereczkei Andras; Wagenlehner Florian; Xiao Yonghong; Yuan Kuo-Ching; Wechsler-Fordos Agnes; Zahar Jean-Ralph; Zakrison Tanya L; Zuckerbraun Brian; Zuidema Wietse P; Catena Fausto
World journal of emergency surgery : WJES
2017
2017
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1186/s13017-017-0145-2" target="_blank" rel="noreferrer noopener">10.1186/s13017-017-0145-2</a>