A Prospective Quality Improvement Program to Reduce Prolonged Postoperative Antibiotic Prophylaxis in Ethiopia.

Autor:	Nofal MR; Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA.; Department of Surgery, Stanford University, Palo Alto, California, USA.; Lifebox, Addis Ababa, Ethiopia.; Global Health Equity Scholars Program (D43TW010540), Fogarty International Center, Washington, District of Columbia, USA., Tesfaye A; Lifebox, Addis Ababa, Ethiopia.; St. Peter's Specialized Hospital, Addis Ababa, Ethiopia., Gebeyehu N; Lifebox, Addis Ababa, Ethiopia.; Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia., Masersha MN; St. Peter's Specialized Hospital, Addis Ababa, Ethiopia., Hayredin I; St. Peter's Specialized Hospital, Addis Ababa, Ethiopia., Belayneh K; St. Peter's Specialized Hospital, Addis Ababa, Ethiopia., Getahun B; St. Peter's Specialized Hospital, Addis Ababa, Ethiopia., Starr N; Lifebox, Addis Ababa, Ethiopia.; Department of Surgery, University of California San Francisco, San Francisco, California, USA., Abebe K; St. Peter's Specialized Hospital, Addis Ababa, Ethiopia., Sebsebe Y; Lifebox, Addis Ababa, Ethiopia., Alemu SB; Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA., Mammo TN; Lifebox, Addis Ababa, Ethiopia.; Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia., Weiser TG; Department of Surgery, Stanford University, Palo Alto, California, USA.; Lifebox, Addis Ababa, Ethiopia.
Jazyk:	angličtina
Zdroj:	Surgical infections [Surg Infect (Larchmt)] 2024 Jul 11. Date of Electronic Publication: 2024 Jul 11.
DOI:	10.1089/sur.2024.059
Abstrakt:	Introduction: Although postoperative antibiotic prophylaxis has not been shown to prevent surgical site infections, prolonged antibiotic administration is common in low- and middle-income countries. We developed a quality improvement program to reduce unnecessary postoperative antibiotics through hospital-specific guideline development and the use of a brief, multidisciplinary discussion of antibiotic indication, choice, and duration during clinical rounds. We assessed reduction in the number of patients receiving ≥24 h of antibiotic prophylaxis after clean and clean-contaminated surgery. Methods: We piloted the program at a referral hospital in Ethiopia from February to September 2023. After a 6-week baseline assessment, multidisciplinary teams adapted international guidelines for surgical prophylaxis to local disease burden, medication availability, and cost restrictions; stakeholders from surgical departments provided feedback. Surgical teams implemented a "timeout" during rounds to apply these guidelines to patient care; compliance with the timeout and antibiotic administration was assessed throughout the study period. Results: We collected data from 636 patients; 159 (25%) in the baseline period and 477 (75%) in the intervention period. The percentage of patients receiving ≥24 h of antibiotic prophylaxis after surgery decreased from 50.9% in the baseline period to 40.9% in the intervention period (p = 0.027) and was associated with a 0.5 day reduction in postoperative length of stay (p = 0.047). Discussion: This antibiotic stewardship pilot program reduced postoperative antibiotic prophylaxis in a resource-constrained setting in Sub-Saharan Africa and was associated with shorter length of stay. This program has the potential to reduce unnecessary antibiotic use in this population.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu