Open AccessAntimicrobial stewardship intervention for the clinical pathways improves antimicrobial prophylaxis in surgical or non‐surgical invasive therapies
Author(s) -
Fujibayashi Ayasa,
Niwa Takashi,
Tsuchiya Mayumi,
Takeichi Syuri,
Suzuki Keiko,
Ohta Hirotoshi,
Yonetamari Jun,
Niwa Ayumi,
Yamamoto Masayo,
Hatakeyama Daijiro,
Baba Hisashi,
Suzuki Akio,
Murakami Nobuo
Publication year - 2019
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.13293
Subject(s) - medicine , antimicrobial stewardship , antimicrobial , discontinuation , interquartile range , antibiotics , hazard ratio , antibiotic prophylaxis , prospective cohort study , surgery , confidence interval , incidence (geometry) , antibiotic resistance , chemistry , physics , organic chemistry , optics , microbiology and biotechnology , biology
Summary Background The standard duration of administration of antimicrobial prophylaxis in surgery and non‐surgical invasive therapy was shortened according to the promotion of appropriate use. Here, we conducted an intervention to optimise antimicrobial prophylaxis by revising all relevant clinical pathways based on the most recent guidelines. Methods We conducted a single‐centre, prospective cohort study in patients who received antimicrobial prophylaxis to evaluate outcomes following revision of the clinical pathways for antimicrobial prophylaxis. Antibiotic consumption and the duration of antibiotic administration were compared before and after revising the clinical pathways. Results Thirty‐five of 171 clinical pathways were considered inappropriate for antimicrobial use and were optimised. After this revision, the duration of antibiotic administration was significantly shortened (before revision: 3 [1‐5] days vs after revision: 2 [1‐3] days, median [interquartile range], P < 0.001). The rate of discontinuation of antibiotics within 48 h after surgery or non‐surgical invasive therapy was significantly higher after the revision (62.4% vs 81.8%, P < 0.001). In contrast, the incidence of surgical site infection (SSI) was not significantly different before and after the revision (5.7% vs 4.3%, P = 0.177). A multivariate Cox proportional analysis indicated that revision of the clinical pathways was one of the prognostic factors associated with the discontinuation of antibiotics within 48 h after surgery or non‐surgical invasive therapy (hazard ratio, 0.69; 95% confidence interval, 0.63‐0.76, P < 0.001). Conclusions Our findings suggest that revising all relevant clinical pathways was highly effective in reducing antibiotic consumption and shortening the antibiotic administration period without increasing the incidence of SSIs.