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>
Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA).
*International Cooperation; *Intraabdominal Infections/diagnosis/drug therapy/microbiology; Anti-Infective Agents/*pharmacology; Drug Resistance; Humans; Microbial; Microbial Sensitivity Tests; Prognosis
Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.
Sartelli Massimo; Weber Dieter G; Ruppe Etienne; Bassetti Matteo; Wright Brian J; Ansaloni Luca; Catena Fausto; Coccolini Federico; Abu-Zidan Fikri M; Coimbra Raul; Moore Ernest E; Moore Frederick A; Maier Ronald V; De Waele Jan J; Kirkpatrick Andrew W; Griffiths Ewen A; Eckmann Christian; Brink Adrian J; Mazuski John E; May Addison K; Sawyer Rob G; Mertz Dominik; Montravers Philippe; Kumar Anand; Roberts Jason A; Vincent Jean-Louis; Watkins Richard R; Lowman Warren; Spellberg Brad; Abbott Iain J; Adesunkanmi Abdulrashid Kayode; Al-Dahir Sara; Al-Hasan Majdi N; Agresta Ferdinando; Althani Asma A; Ansari Shamshul; Ansumana Rashid; Augustin Goran; Bala Miklosh; Balogh Zsolt J; Baraket Oussama; Bhangu Aneel; Beltran Marcelo A; Bernhard Michael; Biffl Walter L; Boermeester Marja A; Brecher Stephen M; Cherry-Bukowiec Jill R; Buyne Otmar R; Cainzos Miguel A; Cairns Kelly A; Camacho-Ortiz Adrian; Chandy Sujith J; Jusoh Asri Che; Chichom-Mefire Alain; Colijn Caroline; Corcione Francesco; Cui Yunfeng; Curcio Daniel; Delibegovic Samir; Demetrashvili Zaza; De Simone Belinda; Dhingra Sameer; Diaz Jose J; Di Carlo Isidoro; Dillip Angel; Di Saverio Salomone; Doyle Michael P; Dorj Gereltuya; Dogjani Agron; Dupont Herve; Eachempati Soumitra R; Enani Mushira Abdulaziz; Egiev Valery N; Elmangory Mutasim M; Ferrada Paula; Fitchett Joseph R; Fraga Gustavo P; Guessennd Nathalie; Giamarellou Helen; Ghnnam Wagih; Gkiokas George; Goldberg Staphanie R; Gomes Carlos Augusto; Gomi Harumi; Guzman-Blanco Manuel; Haque Mainul; Hansen Sonja; Hecker Andreas; Heizmann Wolfgang R; Herzog Torsten; Hodonou Adrien Montcho; Hong Suk-Kyung; Kafka-Ritsch Reinhold; Kaplan Lewis J; Kapoor Garima; Karamarkovic Aleksandar; Kees Martin G; Kenig Jakub; Kiguba Ronald; Kim Peter K; Kluger Yoram; Khokha Vladimir; Koike Kaoru; Kok Kenneth Y Y; Kong Victory; Knox Matthew C; Inaba Kenji; Isik Arda; Iskandar Katia; Ivatury Rao R; Labbate Maurizio; Labricciosa Francesco M; Laterre Pierre-Francois; Latifi Rifat; Lee Jae Gil; Lee Young Ran; Leone Marc; Leppaniemi Ari; Li Yousheng; Liang Stephen Y; Loho Tonny; Maegele Marc; Malama Sydney; Marei Hany E; Martin-Loeches Ignacio; Marwah Sanjay; Massele Amos; McFarlane Michael; Melo Renato Bessa; Negoi Ionut; Nicolau David P; Nord Carl Erik; Ofori-Asenso Richard; Omari AbdelKarim H; Ordonez Carlos A; Ouadii Mouaqit; Junior Gerson Alves Pereira; Piazza Diego; Pupelis Guntars; Rawson Timothy Miles; Rems Miran; Rizoli Sandro; Rocha Claudio; Sakakushev Boris; Sanchez-Garcia Miguel; Sato Norio; Segovia Lohse Helmut A; Sganga Gabriele; Siribumrungwong Boonying; Shelat Vishal G; Soreide Kjetil; Soto Rodolfo; Talving Peep; Tilsed Jonathan V; Timsit Jean Francois; Trueba Gabriel; Trung Ngo Tat; Ulrych Jan; van Goor Harry; Vereczkei Andras; Vohra Ravinder S; Wani Imtiaz; Uhl Waldemar; Xiao Yonghong; Yuan Kuo-Ching; Zachariah Sanoop K; Zahar Jean-Ralph; Zakrison Tanya L; Corcione Antonio; Melotti Rita M; Viscoli Claudio; Viale Perluigi
World journal of emergency surgery : WJES
2016
2016
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/s13017-016-0089-y" target="_blank" rel="noreferrer noopener">10.1186/s13017-016-0089-y</a>