Impact of individualized feedback letters on adherence to surgical antibiotic prophylaxis guidelines: an interrupted time series study (FEEDBACK-ASAP).

BACKGROUND: Surgical antibiotic prophylaxis (SAP) has been proved to decrease the rate of surgical site infections (SSI), but compliance to SAP guidelines remains suboptimal. AIM: This study evaluated the impact of periodically sending individualized feedback letters to surgeons and anesthesiologists on their compliance rate to SAP guidelines. METHODS: A total of 1491 surgeries were evaluated by retrospective chart review during the pre-intervention period and 668 surgeries were evaluated by prospective chart review during the per-intervention period. Finally, 295 letters were sent to 64 surgeons and 45 anesthesiologists. Compliance rate was assessed as an outcome composed of: indication for SAP, choice of antibiotic agent, antibiotic dose, postoperative duration, timing of the preoperative dose and intraoperative redosing. An interrupted time series design was used to assess a difference on compliance rates before and during the intervention period. FINDINGS: Sending individualized feedback letters to surgeons and anesthesiologists did not significantly improve the overall compliance to local SAP guidelines. CONCLUSION: Individualized feedback letters could be part of future interventions directed at improving compliance to SAP guidelines, but are likely insufficient by themselves to provide significant results.

Assessment of antimicrobial prescribing practice, knowledge, and culture in three teaching hospitals.

BACKGROUND: Antimicrobial resistance (AR) is one of the most critical threats to global health. One of its root causes, misuse of antibiotics, can stem from prescribers' preconceived ideas, differing attitudes, and lack of knowledge. Canadian data on this subject are scarce. This study aimed to understand the culture and knowledge of antimicrobial prescribing to optimize strategies targeting prescribers in the local antimicrobial stewardship program (ASP). METHODS: An anonymous online survey was developed and distributed to antimicrobials prescribers at three acute-care teaching hospitals. The questionnaire surveyed perception of AR and ASPs. RESULTS: A total of 440 respondents completed the entire survey. All agreed that AR is a significant challenge in Canada. The vast majority (86%) of respondents believed that AR is a significant problem at their working hospital. However, only 36% of respondents believed that antibiotics are misused locally. Most (92%) agreed that ASPs can decrease AR. Several knowledge gaps were identified through clinical questions. For example, respondents failed to identify treatment indications for asymptomatic bacteriuria 15% of the time and 59% chose an unnecessarily broad antibiotic when presented a microbiology report with susceptibility results associated with a common clinical syndrome. Prescribers' self-reported confidence did not correlate with their knowledge score. CONCLUSIONS: Respondents recognized AR as a critical issue but awareness and knowledge on antibiotic misuse were lacking. As shown in previous studies, respondents see the threat of AR in a more theoretical way. This study provided a better understanding of antimicrobial prescribing practices and ways to optimize them within three teaching hospitals in Montréal. Barriers to optimal antimicrobial prescribing were identified and strategies for improving the effectiveness of the ASP will be developed accordingly.

HISTORIQUE: La résistance antimicrobienne (RA) est l'une des plus graves menaces qui pèsent sur la santé mondiale. L'une de ses causes profondes, le mésusage des antibiotiques, peut découler des idées préconçues, des divergences d'attitudes et du manque de connaissances des prescripteurs. Les données canadiennes sur le sujet sont rares. La présente étude visait à comprendre la culture et les connaissances sur la prescription d'antimicrobiens pour optimiser les stratégies auprès des prescripteurs dans le cadre du programme de gestion des antimicrobiens (PGA) local. MÉTHODOLOGIE: des chercheurs ont préparé un sondage anonyme en ligne et l'ont diffusé auprès des prescripteurs d'antimicrobiens de trois hôpitaux universitaires de soins aigus. Ils ont ainsi sondé la perception de la RA et du PGA. RÉSULTATS: Au total, 440 répondants ont rempli la totalité du sondage. Tous ont indiqué que la RA est un problème important au Canada. La grande majorité des répondants (86 %) étaient d'avis que la RA est un grave problème à l'hôpital où ils travaillent. Cependant, seulement 36 % d'entre eux pensaient que les antibiotiques étaient mal utilisés dans leur localité. La plupart (92 %) convenaient que le PGA peut réduire la RA. Les questions cliniques ont permis de relever plusieurs lacunes. Par exemple, dans 15 % des cas, les répondants n'étaient pas en mesure de déterminer les indications thérapeutiques de la bactériurie asymptomatique, 59 % ont choisi inutilement un antibiotique à large spectre après avoir parcouru un rapport de microbiologie dont les résultats de susceptibilité étaient associés à un syndrome clinique courant. La confiance que déclaraient les prescripteurs n'était pas corrélée avec leurs connaissances. CONCLUSIONS: Les répondants convenaient que la RA était un problème important, mais ne possédaient pas les connaissances nécessaires sur le mésusage des antibiotiques. Comme l'ont démontré des études antérieures, ils perçoivent la menace de la RA sous un angle plutôt théorique. La présente étude a permis de mieux comprendre les pratiques de prescription d'antibiotiques et de relever des moyens de les optimiser dans trois hôpitaux universitaires de Montréal. Les chercheurs ont relevé les obstacles à la prescription optimale d'antimicrobiens et mettront au point des stratégies pour améliorer l'efficacité du PGA en conséquence.

The 2018 Global Point Prevalence Survey of antimicrobial consumption and resistance in 47 Canadian hospitals: a cross-sectional survey.

BACKGROUND: Patient-level surveillance of antimicrobial use (AMU) in Canadian hospitals empowers the reduction of inappropriate AMU and was piloted in 2017 among 14 hospitals in Canada. We aimed to describe AMU on the basis of patient-level data in Canadian hospitals in 2018 in terms of antimicrobial prescribing prevalence and proportions, antimicrobial indications, and agent selection in medical, surgical and intensive care wards. METHODS: Canadian adult, pediatric and neonatal hospitals were invited to participate in the standardized web-based cross-sectional Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) conducted in 2018. An identified site administrator assigned all wards admitting inpatients to specific surveyors. A physician, pharmacist or nurse with infectious disease training performed the survey. The primary outcomes were point prevalence rates for AMU over the study period regarding prescriptions, indications and agent selection in medical, surgical and intensive care wards. The secondary outcomes were AMU for resistant organisms and practice appropriateness evaluated on the basis of quality indicators. Antimicrobial consumption is presented in terms of prevalence and proportions. RESULTS: Forty-seven of 118 (39.8%) hospitals participated in the survey; 9 hospitals were primary care centres, 15 were secondary care centres and 23 were tertiary or specialized care centres. Of 13 272 patients included, 33.5% (n = 4447) received a total of 6525 antimicrobials. Overall, 74.1% (4832/6525) of antimicrobials were for therapeutic use, 12.6% (n = 825) were for medical prophylaxis, 8.9% (n = 578) were for surgical prophylaxis, 2.2% (n = 143) were for other use and 2.3% (n = 147) were for unidentified reasons. A diagnosis or indication was documented in the patient's file at the initiation for 87.3% (n = 5699) of antimicrobials; 62.9% (n = 4106) of antimicrobials had a stop or review date; and 72.0% (n = 4697) of prescriptions were guided by local guidelines. INTERPRETATION: Overall, three-quarters of AMU was for therapeutic use across participating hospitals. Canadian hospitals should be further incentivized to create and adapt local guidelines on the basis of recent antimicrobial resistance data.