Antimicrobial stewardship for surgical antibiotic prophylaxis and surgical site infections: a systematic review
| Autor: | Lucas Borges Pereira, Antônio Alves Pereira Júnior, Tiago Marques dos Reis, Carla Speroni Ceron, André Oliveira Baldoni, Joselin Valeska Martinez-Sobalvarro |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Pharmaceutical Science Pharmacy Toxicology law.invention Antimicrobial Stewardship Anti-Infective Agents Randomized controlled trial law medicine Humans Surgical Wound Infection Antimicrobial stewardship Pharmacology (medical) Antibiotic prophylaxis Intensive care medicine Pharmacology Protocol (science) business.industry Evidence-based medicine Antibiotic Prophylaxis Checklist Anti-Bacterial Agents Clinical trial business |
| Zdroj: | International Journal of Clinical Pharmacy. 44:301-319 |
| ISSN: | 2210-7711 2210-7703 |
| Popis: | Background Surgical site infections account for 14-17% of all healthcare-associated infections. Antimicrobial stewardship (AMS) are complementary strategies developed to optimize the use of antimicrobials. Aim to evaluate the effectiveness of AMS in promoting adherence to surgical antibiotic prophylaxis protocols in hospitalized patients, reducing surgical site infection rate and cost-benefit ratio. Method This systematic review of randomized clinical trials, non-randomized clinical trials and before and after studies was performed using Pubmed, Cochrane, Web of Science, Scopus, Embase, Google Scholar and ClinicalTrials.gov, in addition to reference lists of included studies. The risk of bias of studies was measured by the ROBINS-I checklist and the quality of the evidence synthesis by GRADE. Results Fourteen before and after design studies were included. In 85.7% of the studies, AMS was effective in increasing adherence to surgical antibiotic prophylaxis protocols and in 28.5%, there was reduction in surgical site infection rate. Three studies evaluated cost-benefit ratio and found a favorable impact. Eight (57%) studies were at risk of moderate bias and six had severe bias. The evaluation of the synthesis of evidence showed quality ranging from low to very low. Conclusion AMS, such as audit, feedback, education, implementation of a protocol, and a computer-assisted decision support methodology, appear to be effective in promoting adherence to surgical antibiotic prophylaxis protocols, reducing surgical site infection rate with a positive economic impact. However, more studies, particularly randomized clinical trials, are needed to improve the level of evidence of available information on AMS in order to favor decision-making. |
| Databáze: | OpenAIRE |
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