Implementing antimicrobial stewardship to reduce surgical site infections: Experience and challenges from two...

Area of Science:

• Infectious Diseases
• Public Health
• Surgical Infections

Background:

• Surgical site infections (SSIs) are a major cause of post-surgical complications globally.
• Antimicrobial stewardship programmes (ASPs) are crucial for reducing SSI rates and combating antimicrobial resistance, particularly in resource-limited settings.
• High perioperative antimicrobial use beyond guidelines necessitates effective ASP implementation.

Purpose of the Study:

• To assess the reproducibility of ASP implementation and SSI prevention strategies in a semi-private hospital.
• To compare SSI rates between a government hospital adhering to guidelines and a semi-private hospital implementing the same guidelines.
• To evaluate the impact of guideline adherence on antimicrobial prophylaxis costs.

Main Methods:

• A prospective study comparing SSI prevalence in clean surgeries across two hospital settings (government and semi-private).
• Phase 1: Analysis of SSI rates in a government hospital (n=335) following established guidelines.
• Phase 2: Implementation of the same guidelines in a semi-private hospital (n=235) and subsequent SSI rate analysis; cost comparison of antimicrobial prophylaxis.

Main Results:

• Similar SSI rates were observed in both phases (6.0% vs. 5.1%, P=0.659), indicating reproducibility of the guidelines.
• Higher SSI rates were noted in patients over 50 years old (P=0.0009 and 0.045).
• Antimicrobial prophylaxis costs were significantly lower in the guideline-adherent group (US$0.42 vs. US$9 per patient, P=0.0042).

Conclusions:

• Implementing SSI prevention guidelines and ASPs is feasible and reproducible in diverse hospital settings.
• Adherence to international standards for SSI prevention leads to consistent SSI rates.
• Effective ASP implementation significantly reduces antimicrobial prophylaxis expenditure.