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

Massimo Sartelli 1 Francesco Labricciosa 2 Pamela Barbadoro 2 Leonardo Pagani 3 Luca Ansaloni 4 Adrian Brink 5, 6 Jean Carlet 7 Ashish Khanna 8 Alain Chichom-Mefire 9 Federico Coccolini 10 Salomone Di Saverio 11 Addison May 12 Pierluigi Viale 13 Richard Watkins 8, 14 Luigia Scudeller 15 Lilian Abbo 16 Fikri Abu-Zidan 17 Abdulrashid Adesunkanmi 18 Sara Al-Dahir 19 Majdi Al-Hasan 20 Halil Alis 21 Carlos Alves 22 André Araujo da Silva 23 Goran Augustin 24 Miklosh Bala 25 Philip Barie 26 Marcelo Beltrán 27 Aneel Bhangu 28 Belefquih Bouchra 29 Stephen Brecher 30, 31 Miguel Caínzos Adrian Camacho-Ortiz Marco Catani 32 Sujith Chandy Asri Che Jusoh Jill Cherry-Bukowiec Osvaldo Chiara Elif Colak Oliver Cornely 33 Yunfeng Cui Zaza Demetrashvili Belinda de Simone Jan de Waele Sameer Dhingra Francesco Di Marzo Agron Dogjani Gereltuya Dorj Laurent Dortet Therese Duane Mutasim Elmangory Mushira Enani Paula Ferrada J. Esteban Foianini Mahir Gachabayov Chinmay Gandhi Wagih Mommtaz Ghnnam Helen Giamarellou 34 Georgios Gkiokas Harumi Gomi Tatjana Goranovic Ewen Griffiths Rosio Guerra Gronerth Julio Haidamus Monteiro Timothy Hardcastle Andreas Hecker Adrien Hodonou Orestis Ioannidis Arda Isik Katia Iskandar Hossein Kafil Souha Kanj Lewis Kaplan Garima Kapoor Aleksandar Karamarkovic Jakub Kenig Ivan Kerschaever Faryal Khamis Vladimir Khokha Ronald Kiguba Hong Kim Wen-Chien Ko Kaoru Koike Iryna Kozlovska Anand Kumar 35 Leonel Lagunes Rifat Latifi Jae Lee 36 Young Lee Ari Leppäniemi Yousheng Li 37 Stephen Liang Warren Lowman Gustavo Machain Marc Maegele Piotr Major Sydney Malama Ramiro Manzano-Nunez Athanasios Marinis Isidro Martinez Casas Sanjay Marwah Emilio Maseda Michael Mcfarlane Ziad Memish Dominik Mertz Cristian Mesina Shyam Mishra Ernest Moore Akutu Munyika Eleftherios Mylonakis Lena Napolitano Ionut Negoi Milica Nestorovic David Nicolau Abdelkarim Omari Carlos Ordonez 38 José-Artur Paiva 39 Narayan Pant Jose Parreira Michal Pędziwiatr Bruno Pereira 40 Alfredo Ponce-De-Leon Garyphallia Poulakou 41 Jacobus Preller Céline Pulcini 42 Guntars Pupelis Martha Quiodettis Timothy Rawson Tarcisio Reis Miran Rems Sandro Rizoli Jason Roberts 43 Nuno Rocha Pereira Jesús Rodríguez-Baño 44 Boris Sakakushev James Sanders Natalia Santos Norio Sato Robert Sawyer Sandro Scarpelini Loredana Scoccia Nusrat Shafiq Vishalkumar Shelat Costi Sifri Boonying Siribumrungwong Kjetil Søreide Rodolfo Soto Hamilton de Souza Peep Talving Ngo Tat Trung Jeffrey 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 45 Tanya Zakrison Brian Zuckerbraun Wietse Zuidema Fausto Catena
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.
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Submitted on : Thursday, October 31, 2019 - 12:33:10 PM
Last modification on : Wednesday, November 3, 2021 - 8:09:20 AM

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Massimo Sartelli, Francesco Labricciosa, Pamela Barbadoro, Leonardo Pagani, Luca Ansaloni, et al.. 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, BioMed Central, 2017, 12, pp.34. ⟨10.1186/s13017-017-0145-2⟩. ⟨hal-02341331⟩

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