Zagorka Popovski1, Mathew Mercuri2, Cheryl Main3, Niv Sne4, Kate Walsh5, Melani Sung6, Timothy Rice7, Dominik Mertz8. 1. Hamilton Health Sciences, Hamilton, ON, Canada London Health Sciences, London, ON, Canada. 2. Department of Medicine, Division of Cardiology, Columbia University, New York, NY, USA Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 3. Hamilton Health Sciences, Hamilton, ON, Canada Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada. 4. Hamilton Health Sciences, Hamilton, ON, Canada Department of Surgery, McMaster University, Hamilton, ON, Canada. 5. Hamilton Health Sciences, Hamilton, ON, Canada Integrated Pharmacy Services, Women's College Hospital, Toronto, ON, Canada. 6. Hamilton Health Sciences, Hamilton, ON, Canada Department of Medicine, McMaster University, Hamilton, ON, Canada. 7. Department of Surgery, McMaster University, Hamilton, ON, Canada. 8. Hamilton Health Sciences, Hamilton, ON, Canada Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada Department of Medicine, McMaster University, Hamilton, ON, Canada Michael G. DeGroote Institute for Infectious Disease Research, Hamilton, ON, Canada mertzd@mcmaster.ca.
Abstract
OBJECTIVES: Implementing evidence-based practice guidelines is challenging. We used a multifaceted, continuous educational approach to disseminate an up-to-date internal guideline adapted from published guidelines for management of intra-abdominal infections (IAI). PATIENTS AND METHODS: The intervention consisted of continuing educational sessions, internal guideline pocket cards and posters with collaboration among all key stakeholders starting in December 2010. We emphasized risk stratification and the use of ceftriaxone/metronidazole for treatment of low-risk IAI, and discouraged the use of fluoroquinolones due to the high local resistance rates. We then compared patients with IAI before the intervention (April-November 2010) to those after implementation of the guideline (April-November 2011) in a surgical unit at a tertiary care teaching hospital in Hamilton, Ontario, Canada. Antibiotic use was measured in in-hospital days of antibiotic therapy (DOT) per 1000 patient days (PD). RESULTS: 152 and 145 patients with IAI were included in the pre- and post-intervention periods, respectively. There was a significant reduction in the proportion of patients who received ciprofloxacin therapy from 74% to 34% (OR 0.18, 95% CI 0.11-0.31) and in DOT/1000 PD from 221 to 74 (OR 0.3, 95% CI 0.2-0.3). Also, a reduction in the DOT/1000 PD for piperacillin/tazobactam was seen (from 116 to 67; OR 0.6, 95% CI 0.5-0.7). There was an increase in the use of ceftriaxone from 1.3% to 53% of patients (OR 85, 95% CI 20-515) and from 6 to 92 DOT/1000 PD (OR 17, 95% CI 10-25). This change in practice was sustained over >2 years since the end of the active intervention, as shown in the unit-wide antimicrobial utilization data. CONCLUSIONS: A multifaceted intervention aimed at all key stakeholders resulted in a high adherence to evidence-based treatment guidelines for IAI and has initiated a sustained culture change in prescribing of antibiotics.
OBJECTIVES: Implementing evidence-based practice guidelines is challenging. We used a multifaceted, continuous educational approach to disseminate an up-to-date internal guideline adapted from published guidelines for management of intra-abdominal infections (IAI). PATIENTS AND METHODS: The intervention consisted of continuing educational sessions, internal guideline pocket cards and posters with collaboration among all key stakeholders starting in December 2010. We emphasized risk stratification and the use of ceftriaxone/metronidazole for treatment of low-risk IAI, and discouraged the use of fluoroquinolones due to the high local resistance rates. We then compared patients with IAI before the intervention (April-November 2010) to those after implementation of the guideline (April-November 2011) in a surgical unit at a tertiary care teaching hospital in Hamilton, Ontario, Canada. Antibiotic use was measured in in-hospital days of antibiotic therapy (DOT) per 1000 patient days (PD). RESULTS: 152 and 145 patients with IAI were included in the pre- and post-intervention periods, respectively. There was a significant reduction in the proportion of patients who received ciprofloxacin therapy from 74% to 34% (OR 0.18, 95% CI 0.11-0.31) and in DOT/1000 PD from 221 to 74 (OR 0.3, 95% CI 0.2-0.3). Also, a reduction in the DOT/1000 PD for piperacillin/tazobactam was seen (from 116 to 67; OR 0.6, 95% CI 0.5-0.7). There was an increase in the use of ceftriaxone from 1.3% to 53% of patients (OR 85, 95% CI 20-515) and from 6 to 92 DOT/1000 PD (OR 17, 95% CI 10-25). This change in practice was sustained over >2 years since the end of the active intervention, as shown in the unit-wide antimicrobial utilization data. CONCLUSIONS: A multifaceted intervention aimed at all key stakeholders resulted in a high adherence to evidence-based treatment guidelines for IAI and has initiated a sustained culture change in prescribing of antibiotics.
Authors: Massimo Sartelli; Therese M Duane; Fausto Catena; Jeffrey M Tessier; Federico Coccolini; Lillian S Kao; Belinda De Simone; Francesco M Labricciosa; Addison K May; Luca Ansaloni; John E Mazuski Journal: Surg Infect (Larchmt) Date: 2016-11-09 Impact factor: 2.150
Authors: Katherine M Shea; Athena L V Hobbs; Theresa C Jaso; Jack D Bissett; Christopher M Cruz; Elizabeth T Douglass; Kevin W Garey Journal: Antimicrob Agents Chemother Date: 2017-05-24 Impact factor: 5.191
Authors: Peter Davey; Charis A Marwick; Claire L Scott; Esmita Charani; Kirsty McNeil; Erwin Brown; Ian M Gould; Craig R Ramsay; Susan Michie Journal: Cochrane Database Syst Rev Date: 2017-02-09