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World J Emerg Surg. 2017 Aug 1;12:34. doi: 10.1186/s13017-017-0145-2. eCollection 2017.

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

Sartelli M1, Labricciosa FM2, Barbadoro P2, Pagani L3, Ansaloni L4, Brink AJ5,6, Carlet J7, Khanna A8, Chichom-Mefire A9, Coccolini F10, Di Saverio S11, May AK12, Viale P13, Watkins RR14,15, Scudeller L16, Abbo LM17, Abu-Zidan FM18, Adesunkanmi AK19, Al-Dahir S20, Al-Hasan MN21, Alis H22, Alves C23, Araujo da Silva AR24, Augustin G25, Bala M26, Barie PS27, Beltrán MA28, Bhangu A29, Bouchra B30, Brecher SM31,32, Caínzos MA33, Camacho-Ortiz A34, Catani M35, Chandy SJ36, Jusoh AC37, Cherry-Bukowiec JR38, Chiara O39, Colak E40, Cornely OA41, Cui Y42, Demetrashvili Z43, De Simone B44, De Waele JJ45, Dhingra S46,47, Di Marzo F48, Dogjani A49, Dorj G50, Dortet L51, Duane TM52, Elmangory MM53, Enani MA54, Ferrada P55, Esteban Foianini J56, Gachabayov M57, Gandhi C58, Ghnnam WM59, Giamarellou H60, Gkiokas G61, Gomi H62, Goranovic T63, Griffiths EA64, Guerra Gronerth RI65, Haidamus Monteiro JC66, Hardcastle TC67, Hecker A68, Hodonou AM69, Ioannidis O70, Isik A71, Iskandar KA72, Kafil HS73, Kanj SS74, Kaplan LJ75, Kapoor G76, Karamarkovic AR77, Kenig J78, Kerschaever I79, Khamis F80, Khokha V81, Kiguba R82, Kim HB83, Ko WC84, Koike K85, Kozlovska I86, Kumar A87, Lagunes L88, Latifi R89, Lee JG90, Lee YR91, Leppäniemi A92, Li Y93, Liang SY94, Lowman W95, Machain GM96, Maegele M97, Major P98, Malama S99, Manzano-Nunez R100, Marinis A101, Martinez Casas I102, Marwah S103, Maseda E104, McFarlane ME105, Memish Z106, Mertz D107, Mesina C108, Mishra SK109, Moore EE110, Munyika A111, Mylonakis E112, Napolitano L113, Negoi I114, Nestorovic MD115, Nicolau DP116, Omari AH117, Ordonez CA118, Paiva JA119, Pant ND120, Parreira JG121, Pędziwiatr M122, Pereira BM123, Ponce-de-Leon A124, Poulakou G125, Preller J126, Pulcini C127, Pupelis G128, Quiodettis M129, Rawson TM130, Reis T131, Rems M132, Rizoli S133, Roberts J134, Pereira NR23, Rodríguez-Baño J135, Sakakushev B136, Sanders J137, Santos N138, Sato N139, Sawyer RG140, Scarpelini S141, Scoccia L142, Shafiq N143, Shelat V144, Sifri CD145, Siribumrungwong B146, Søreide K147,148, Soto R149, de Souza HP150, Talving P151, Trung NT152, Tessier JM153, Tumbarello M154, Ulrych J155, Uranues S156, Van Goor H157, Vereczkei A158, Wagenlehner F159, Xiao Y160, Yuan KC161, Wechsler-Fördös A162, Zahar JR163, Zakrison TL164, Zuckerbraun B165, Zuidema WP166, Catena F167.

Author information

1
Department of Surgery, Macerata Hospital, Macerata, Italy.
2
Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy.
3
Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy.
4
General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
5
Department of Clinical microbiology, Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa.
6
Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape town, South Africa.
7
World Alliance against Antibiotics Resistance, Rome, Italy.
8
Center for Critical Care, Anaesthesiology Institute and Department of Outcomes Research, Cleveland Clinic, Cleveland, OH USA.
9
Department of Surgery and Obstetrics/Gynaecology, Regional Hospital, Limbe, Cameroon.
10
Department of Surgery, Infermi Hospital, Rimini, Italy.
11
Department of Surgery, Maggiore Hospital, Bologna, Italy.
12
Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee USA.
13
Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.
14
Division of Infectious Diseases, Cleveland Clinic Akron General, Akron, OH USA.
15
Department of Medicine, Northeast Ohio Medical University, Rootstown, OH USA.
16
Clinical Epidemiology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
17
Division of Infectious Diseases, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL USA.
18
Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
19
Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
20
Division of Clinical and Administrative Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA USA.
21
Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC USA.
22
General Surgery Department, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Instanbul, Turkey.
23
Unit of Prevention and Infection Control, Center of Hospital Epidemiology, São João Hospital Centre, Porto, Portugal.
24
Infection Control Committee, Prontobaby Hospital da Criança, Rio de Janeiro, Brazil.
25
Department of Surgery, University Hospital Center, Zagreb, Croatia.
26
Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
27
Department of Surgery, Weill Cornell Medicine, New York, NY USA.
28
Department of General Surgery, Hospital San Juan de Dios de La Serena, La Serena, Chile.
29
Academic Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK.
30
Department of Microbiology National Reference Laboratory Cheikh Khalifa Ibn Zaid Hospital, Mohammed 6th University of Health Sciences, Casablanca, Morocco.
31
Department of Pathology and Laboratory Medicine, VA Boston HealthCare System, Boston, MA USA.
32
Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA USA.
33
Department of Surgery, Hospital Clínico Universitario, Santiago de Compostela, Spain.
34
Hospital Epidemiology and Infectious Diseases, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Mexico.
35
Department of Emergency, Umberto I Hospital, Rome, Italy.
36
Department of Pharmacology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala India.
37
Department of General Surgery, Kuala Krai Hospital, Kuala Krai, Kelantan Malaysia.
38
Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI USA.
39
Niguarda Hospital, Milano, Italy.
40
Department of General Surgery, Health Sciences University, Samsun Training and Research Hospital, Samsun, Turkey.
41
Department of Internal Medicine and Infectious Diseases, University of Cologne, Cologne, Germany.
42
Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China.
43
Department General Surgery, Kipshidze Central University Hospital, Tbilisi, Georgia.
44
Department of Digestive Surgery, Cannes Hospital, Cannes, France.
45
Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium.
46
School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
47
Eric Williams Medical Sciences Complex, Uriah Butler Highway, Champ Fleurs, Trinidad and Tobago.
48
Department of Surgery, Versilia Hospita, Lido di Camaiore, Italy.
49
Department of Surgery, University Hospital of Trauma, Tirana, Albania.
50
School of Pharmacy and Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
51
Department of Microbiology, Bicêtre Hospital, Paris-Sud University, La Kremlin-Bicêtre, France.
52
Department of Surgery, John Peter Smith Health Network, Fort Worth, Texas USA.
53
Sudan National Public Health Laboratory, Federal Ministry of Health, Khartoum, Sudan.
54
Department of Medicine, Infectious Disease Division, King Fahad Medical City, Riyadh, Saudi Arabia.
55
Department of Surgery, Virginia Commonwealth University, Richmond, VA USA.
56
Department of Surgery, Clinica Foianini, Santa Cruz, Bolivia.
57
Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia.
58
Department of Surgery, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra India.
59
Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
60
Sixth Department of Internal Medicine, Hygeia General Hospital, Athens, Greece.
61
Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
62
Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Mito, Ibaraki Japan.
63
University Department for Tumours, Sestre Milosrrdnice UHC, Zagreb, Croatia.
64
General and Upper GI Surgery, Queen Elizabeth Hospital, Birmingham, UK.
65
Peruvian Navy Medical Center, Lima, Peru.
66
Department of Gastrointestinal Surgery, Santa Casa Hospital, Campo Grande, Brazil.
67
Trauma and Trauma ICU, Inkosi Albert Luthuli Central Hospital and Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
68
Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany.
69
Department of Surgery, Faculty of Medicine, University of Parakou, BP 123 Parakou, Benin.
70
Fourth Surgical Department, General Hospital G. Papanikolaou, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
71
Department of General Surgery, Erzincan University, Faculty of Medicine, Erzincan, Turkey.
72
Department of Pharmacy, Lebanese, International University, Beirut, Lebanon.
73
Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
74
Division of Infectious Diseases, American University of Beirut, Beirut, Lebanon.
75
Department of Surgery Philadelphia VA Medical Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.
76
Department of Microbiology, Gandhi Medical College, Bhopal, India.
77
Clinic for Emergency Surgery, Medical Faculty University of Belgrade, Belgrade, Serbia.
78
Third Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
79
Department of Abdominal Surgery, Regional Hospital of Tienen, Tienen, Belgium.
80
Department of Internal Medicine, Royal Hospital, Muscat, Oman.
81
Department of Emergency Surgery, City Hospital, Mozyr, Belarus.
82
Department of Pharmacology and Therapeutics, College of Health Sciences, Makerere University, Kampala, Uganda.
83
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
84
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
85
Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
86
Department of Surgery n. 2, Higher educational institutions of Ukraine Bukovina State Medical University, Chernivtci City, Ukraine.
87
Section of Critical Care Medicine and Section of Infectious Diseases, Department of Medicine, Medical Microbiology and Pharmacology/Therapeutics, University of Manitoba, Winnipeg, MB Canada.
88
Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico.
89
Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ USA.
90
Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
91
Texas Tech University, Health Sciences Center School of Pharmacy, Abilene, TX USA.
92
Abdominal Center, University Hospital Meilahti, Helsinki, Finland.
93
Department of Surgery, Inling Hospital, Nanjing University School of Medicine, Nanjing, China.
94
Division of Infectious Diseases, Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO USA.
95
Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
96
Department of Surgery, Universidad Nacional de Asuncion, Asuncion, Paraguay.
97
Department for Traumatology and Orthopedic Surgery, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke (UW/H), Cologne, Germany.
98
Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
99
Health Research Program, Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia.
100
Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia.
101
First Department of Surgery, Tzaneion General Hospital, Piraeus, Greece.
102
Service of General Surgery, Hospital Complex of Jaén, Jaén, Spain.
103
Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India.
104
Servicio de Anestesia y Reanimación, Hospital Universitario La Paz Madrid, Madrid, Spain.
105
Department of Surgery, Radiology, University Hospital of the West Indies, Kingston, Jamaica.
106
Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia.
107
Departments of Medicine, Clinical Epidemiology and Biostatistics, and Pathology and Molecular Medicine, McMaster University, Hamilton, ON Canada.
108
Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Romania.
109
Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.
110
Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA.
111
Department of Surgery, Onandjokwe Hospital, Ondangwa, Namibia.
112
Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI USA.
113
Department of Surgery, University of Michigan, Ann Arbor, MI USA.
114
Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania.
115
Clinic for General Surgery, Clinical Centre, Nis, Serbia.
116
Center of Anti-Infective Research and Development, Hartford, CT USA.
117
Department of Surgery, King Abdullah University Hospital, Irbid, Jordan.
118
Department of Surgery and Critical Care, Universidad del Valle, Fundación Valle del Lili, Cali, Colombia.
119
Intensive Care Medicine Department, Centro Hospitalar São João, University of Porto, Porto, Portugal.
120
Department of Microbiology, Grande International Hospital, Dhapasi, Kathmandu, Nepal.
121
Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil.
122
Department of General and Emergency Surgery, University Hospital Kraków, Kraków, Poland.
123
Department of Surgery, University of Campinas, Campinas, Brazil.
124
Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
125
Fourth Department of Internal Medicine and Infectious Diseases Unit, National and Kapodstrian University-Medical School, Attikon University General Hospital, Athens, Greece.
126
John Farman Intensive Care Unit, University Hospitals, NHS Foundation Trust, Cambridge, UK.
127
Infectious and Tropical Diseases Department, University Hospital of Nancy, and EA 4360 APEMAC, Lorraine University, Nancy, France.
128
Department of General and Emergency Surgery, Riga East University Hospital 'Gailezers', Riga, Latvia.
129
Department of Trauma, Hospital Santo Tomas, Panama, Panama.
130
National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK.
131
Emergency Post-operative Department, Otavio de Freitas Hospital and Hosvaldo Cruz Hospital, Recife, Brazil.
132
Department of General Surgery, Jesenice General Hospital, Jesenice, Slovenia.
133
Trauma and Acute Care Service, St Michael's Hospital, University of Toronto, Toronto, Canada.
134
Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland Australia.
135
Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBiS and Departamento de Medicina, Universidad de Sevilla, Seville, Spain.
136
General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria.
137
JPS Health Network, Texas, TX USA.
138
Hospital Center Tondela Viseu, Tondela, Portugal.
139
Department of Aeromedical Services for Emergency and Trauma Care, Ehime University Graduate School of Medicine, Ehime, Japan.
140
Department of Surgery, University of Virginia Health System, Charlottesville, VA USA.
141
Department of Surgery, University of Sao Paulo, Ribeirao Preto, Brazil.
142
Unit of Hospital Pharmacy, Macerata Hospital, Macerata, Italy.
143
Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
144
Department of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore.
145
Office of Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, VA USA.
146
Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand.
147
Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
148
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
149
Department of Emergency Surgery and Critical Care, Centro Medico Imbanaco, Cali, Colombia.
150
Department of Surgery, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
151
Department of Surgery, North Estonia Medical Center, Tallinn, Estonia.
152
Department of Molecular Biology, Tran Hung Dao Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam.
153
Department of Infectious Diseases, John Peter Smith Health Network, Fort Worth, Texas USA.
154
Institute of Infectious Diseases, Catholic University, Rome, Italy.
155
First Department of Surgery-Department of Abdominal, Thoracic Surgery and Traumatology, General University Hospital, Prague, Czech Republic.
156
Department of Surgery, Medical University of Graz, Graz, Austria.
157
Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
158
Department of Surgery, Medical School University of Pécs, Pécs, Hungary.
159
Department of Urology, Pediatric Urology and Andrology, Medical Faculty of the Justus Liebig University Giessen, Giessen, Germany.
160
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affilliated Hospital, Zhejiang University, Zhejiang, China.
161
Trauma and Emergency Surgery Department, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
162
Department of Antibiotics and Infection Control, Rudolfstiftung Hospital, Vienna, Austria.
163
Infection Control Unit, Angers University, CHU d'Angers, Angers, France.
164
Division of Trauma and Surgical Critical Care, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL USA.
165
Department of Surgery, University of Pittsburgh, Pittsburgh, PA USA.
166
VU University Medical Center, Amsterdam, The Netherlands.
167
Department of General Surgery, Maggiore Hospital, Parma, Italy.

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

PMID:
28775763
PMCID:
PMC5540347
DOI:
10.1186/s13017-017-0145-2
[Indexed for MEDLINE]
Free PMC Article

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