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Impact of a new perioperative antibiotic prophylaxis policy on the antimicrobial resistance: experience in a comprehensive cancer centre

Abstract number: R2439

Passerini R., Biffi R., Riggio D., Moretti L., Sandri M.

Objectives: The use of inappropriate or broad-spectrum antibiotics in perioperative prophylaxis is a significant cause of antimicrobial resistance in hospital.

To reduce this problem, the adherence to shared guidelines represents a key step. Aim of our study was to evaluate the effectiveness of the compliance with newly introduced guidelines in decreasing the antimicrobial resistance of hospital bacteria.

Methods: At the European Institute of Oncology, until 2002 each division followed an internal perioperative antibiotic prophylaxis schedule. In November 2002 new guidelines were published, establishing, for each surgical procedure, the appropriate choice of antibiotic, the way, timing and duration of administration, and the alternative drugs in case of allergic patients. Meetings with the clinicians, to discuss and share the new indications, training courses for all the medical and nursing staff were organised, and periodical checks to verify the compliance with these indications were performed. To evaluate the effect of this new policy, we compared, in surgical patients, the antimicrobial resistances of the isolated bacteria, both pathogen and colonising, before and after the introduction of the guidelines.

Results: With regard to compliance with the new guidelines, the ratio of totally correct prophylaxis increased from 39.7% to 54.8% (ratio of correct active principle from 52.9% to 96.7%).

The antimicrobial sensitivity of isolated bacteria increased overall from 72% to 76% (Wilcoxon, p = 0.0019); in particular, a significant increase in the susceptibility to tested antibiotics occurred for Staphylococcus aureus, Coagulase Negative staphylococci (CoNS) and Pseudomonas species; on the contrary, for Enterobacteria there was an increase of the resistance, and for the other Gram-negative and the Enterococci no significant variations were found (Tab. 1).

Table 1. Percentage of antibiotic susceptibility in 2002 and 2005 and significance of the variation

Conclusions: The introduction of guidelines for perioperative prophylaxis and the compliance with their indications were fundamental to regulate the appropriate use of antibiotics, but it is also necessary that these guidelines are shared with all the staff. It is also essential to train all healthcare staff about the right use of the drugs, with training activities, organised by the Infections Control Committee in co-operation with clinicians, microbiologists and pharmacologists, regarding the diagnosis and treatment of infections and the need to contain and face the increase of antibiotic resistance.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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