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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 M Labricciosa  2 Pamela Barbadoro  2 Leonardo Pagani  3 Luca Ansaloni  4 Adrian J Brink  5   6 Jean Carlet  7 Ashish Khanna  8 Alain Chichom-Mefire  9 Federico Coccolini  10 Salomone Di Saverio  11 Addison K May  12 Pierluigi Viale  13 Richard R Watkins  14   15 Luigia Scudeller  16 Lilian M Abbo  17 Fikri M Abu-Zidan  18 Abdulrashid K Adesunkanmi  19 Sara Al-Dahir  20 Majdi N Al-Hasan  21 Halil Alis  22 Carlos Alves  23 André R Araujo da Silva  24 Goran Augustin  25 Miklosh Bala  26 Philip S Barie  27 Marcelo A Beltrán  28 Aneel Bhangu  29 Belefquih Bouchra  30 Stephen M Brecher  31   32 Miguel A Caínzos  33 Adrian Camacho-Ortiz  34 Marco Catani  35 Sujith J Chandy  36 Asri Che Jusoh  37 Jill R Cherry-Bukowiec  38 Osvaldo Chiara  39 Elif Colak  40 Oliver A Cornely  41 Yunfeng Cui  42 Zaza Demetrashvili  43 Belinda De Simone  44 Jan J De Waele  45 Sameer Dhingra  46   47 Francesco Di Marzo  48 Agron Dogjani  49 Gereltuya Dorj  50 Laurent Dortet  51 Therese M Duane  52 Mutasim M Elmangory  53 Mushira A Enani  54 Paula Ferrada  55 J Esteban Foianini  56 Mahir Gachabayov  57 Chinmay Gandhi  58 Wagih Mommtaz Ghnnam  59 Helen Giamarellou  60 Georgios Gkiokas  61 Harumi Gomi  62 Tatjana Goranovic  63 Ewen A Griffiths  64 Rosio I Guerra Gronerth  65 Julio C Haidamus Monteiro  66 Timothy C Hardcastle  67 Andreas Hecker  68 Adrien M Hodonou  69 Orestis Ioannidis  70 Arda Isik  71 Katia A Iskandar  72 Hossein S Kafil  73 Souha S Kanj  74 Lewis J Kaplan  75 Garima Kapoor  76 Aleksandar R Karamarkovic  77 Jakub Kenig  78 Ivan Kerschaever  79 Faryal Khamis  80 Vladimir Khokha  81 Ronald Kiguba  82 Hong B Kim  83 Wen-Chien Ko  84 Kaoru Koike  85 Iryna Kozlovska  86 Anand Kumar  87 Leonel Lagunes  88 Rifat Latifi  89 Jae G Lee  90 Young R Lee  91 Ari Leppäniemi  92 Yousheng Li  93 Stephen Y Liang  94 Warren Lowman  95 Gustavo M Machain  96 Marc Maegele  97 Piotr Major  98 Sydney Malama  99 Ramiro Manzano-Nunez  100 Athanasios Marinis  101 Isidro Martinez Casas  102 Sanjay Marwah  103 Emilio Maseda  104 Michael E McFarlane  105 Ziad Memish  106 Dominik Mertz  107 Cristian Mesina  108 Shyam K Mishra  109 Ernest E Moore  110 Akutu Munyika  111 Eleftherios Mylonakis  112 Lena Napolitano  113 Ionut Negoi  114 Milica D Nestorovic  115 David P Nicolau  116 Abdelkarim H Omari  117 Carlos A Ordonez  118 José-Artur Paiva  119 Narayan D Pant  120 Jose G Parreira  121 Michal Pędziwiatr  122 Bruno M Pereira  123 Alfredo Ponce-de-Leon  124 Garyphallia Poulakou  125 Jacobus Preller  126 Céline Pulcini  127 Guntars Pupelis  128 Martha Quiodettis  129 Timothy M Rawson  130 Tarcisio Reis  131 Miran Rems  132 Sandro Rizoli  133 Jason Roberts  134 Nuno Rocha Pereira  23 Jesús Rodríguez-Baño  135 Boris Sakakushev  136 James Sanders  137 Natalia Santos  138 Norio Sato  139 Robert G Sawyer  140 Sandro Scarpelini  141 Loredana Scoccia  142 Nusrat Shafiq  143 Vishalkumar Shelat  144 Costi D Sifri  145 Boonying Siribumrungwong  146 Kjetil Søreide  147   148 Rodolfo Soto  149 Hamilton P de Souza  150 Peep Talving  151 Ngo Tat Trung  152 Jeffrey M Tessier  153 Mario Tumbarello  154 Jan Ulrych  155 Selman Uranues  156 Harry Van Goor  157 Andras Vereczkei  158 Florian Wagenlehner  159 Yonghong Xiao  160 Kuo-Ching Yuan  161 Agnes Wechsler-Fördös  162 Jean-Ralph Zahar  163 Tanya L Zakrison  164 Brian Zuckerbraun  165 Wietse P Zuidema  166 Fausto Catena  167
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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 et al. World J Emerg Surg.

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.

Keywords: Antibiotics; Antimicrobial stewardship; Infections; Surgery.

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The authors declare that they have no competing interests.

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References

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