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Antimicrobial Stewardship in oral and maxillofacial surgery: melting the iceberg
Insa Joost1, Melanie Kempe2, Barbara Eirmbter3
1Institute of Medical Microbiology and Hospital Hygiene, University Hospital Duesseldorf, Duesseldorf, Germany.
Objective:
Irrational antibiotic consumption contributes to antimicrobial resistance, adverse effects, and rising costs. Antimicrobial Stewardship (AMS) supports rational antibiotic use through restrictive and supportive measures. In oral and maxillofacial surgery (OMFS), antibiotic consumption is consistently high, and evidence-based guidelines are often lacking. We evaluated a multimodal AMS intervention on antibiotic use in an OMFS department.
Design:
Before-after study.
Setting:
OMFS department of a German university hospital.
Patients:
Hospitalized patients treated in the OMFS department.
Intervention:
For 12 months, the AMS team conducted weekly ward visits, providing recommendations regarding antibiotic therapy and surgical antibiotic prophylaxis (SAP). In parallel, a mandatory consensus guideline covering these aspects was developed and implemented. Antibiotic use, prevalence, duration of therapy, and SAP before, during, and after the intervention were evaluated; clinical outcomes were not assessed.
Results:
Pre-intervention, over 70% of patients received antibiotics. Median duration of antibiotic therapy and SAP was 12 and 9 days, respectively. Antibiotic consumption reached 63.8 defined daily dosages per 100 patient days, exceeding national values (median 40.1). During the intervention, antibiotic prevalence decreased below 50% and the duration of antibiotic therapy and SAP was shortened to 9 and 3 days, respectively. Antibiotic consumption decreased by 26% whereas national values increased by nearly 50%. After weekly consultations ceased, antibiotic use rose again but remained below national levels.
Conclusions:
Antibiotic consumption is high in OMFS. Regular AMS support including consensus guidelines can reduce antibiotic use substantially and sustainably. However, clinical outcomes need to be correlated and adequately staffed AMS teams are needed.
Insights
Implementing antimicrobial stewardship (AMS) interventions significantly reduced antibiotic use in oral and maxillofacial surgery (OMFS). This approach, combining ward visits and guidelines, lowered consumption and duration of therapy, demonstrating AMS
Area of Science:
- Oral and Maxillofacial Surgery
- Infectious Diseases
- Healthcare Management
Background:
- Irrational antibiotic use in oral and maxillofacial surgery (OMFS) drives antimicrobial resistance, adverse effects, and costs.
- Evidence-based guidelines for antibiotic use in OMFS are often lacking.
- Antimicrobial Stewardship (AMS) programs aim to optimize antibiotic prescribing.
Purpose of the Study:
- To evaluate a multimodal AMS intervention's impact on antibiotic consumption in an OMFS department.
- To assess changes in antibiotic use prevalence, duration, and surgical antibiotic prophylaxis (SAP).
Main Methods:
- A before-after study design was employed in a German university hospital's OMFS department.
- A 12-month intervention included weekly AMS team ward visits and recommendations.
- A mandatory consensus guideline for antibiotic therapy and SAP was developed and implemented.
Main Results:
- Pre-intervention, over 70% of patients received antibiotics, with median therapy durations of 12 days (antibiotics) and 9 days (SAP).
- Antibiotic consumption was 63.8 defined daily dosages (DDDs)/100 patient days, exceeding national medians.
- During intervention, antibiotic prevalence dropped below 50%, durations shortened to 9 and 3 days, and consumption decreased by 26%.
Conclusions:
- Multimodal AMS interventions, including regular support and consensus guidelines, can substantially reduce antibiotic use in OMFS.
- Sustained reduction in antibiotic consumption was observed, even after direct consultations ceased.
- Adequately staffed AMS teams and correlation with clinical outcomes are crucial for future efforts.
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