Background: The aim of this study was to assess the impact of antimicrobial stewardship interventions on surgical antibiotic prescription behavior in the management of non-elective surgical intra-abdominal infections, focusing on postoperative antibiotic use, including the appropriateness of indications. Methods: A single-center quality improvement study with retrospective evaluation of the impact of antimicrobial stewardship measures on optimizing antibacterial use in intra-abdominal infections requiring emergency surgery was performed. The study was conducted in a tertiary hospital in Germany from January 1, 2016, to January 30, 2020, three years after putting a set of antimicrobial stewardship standards into effect. Results: 767 patients were analyzed (n = 495 in 2016 and 2017, the baseline period; n = 272 in 2018, the antimicrobial stewardship period). The total days of therapy per 100 patient days declined from 47.0 to 42.2 days (p = 0.035). The rate of patients receiving postoperative therapy decreased from 56.8% to 45.2% (p = 0.002), comparing both periods. There was a significant decline in the rate of inappropriate indications (17.4% to 8.1 %, p = 0.015) as well as a significant change from broad-spectrum to narrow-spectrum antibiotic use (28.8% to 6.5%, p ≤ 0.001) for postoperative therapy. The significant decline in antibiotic use did not affect either clinical outcomes or the rate of postoperative wound complications. Conclusions: Postoperative antibiotic use for intra-abdominal infections could be significantly reduced by antimicrobial stewardship interventions. The identification of inappropriate indications remains a key target for antimicrobial stewardship programs.

中文翻译：

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定义“抗菌药物管理干预措施的范围”对外科腹腔内感染抗生素的处方质量

背景：本研究的目的是评估抗菌药物管理干预对非选择性手术性腹腔内感染管理中手术抗生素处方行为的影响，重点是术后抗生素的使用，包括适应症的适用性。方法：进行了一项单中心质量改善研究，回顾性评估了抗菌药物管理措施对需要急诊手术的腹腔内感染的抗菌药物使用优化的影响。该研究于2016年1月1日至2020年1月30日在德国一家三级医院进行，这是一套抗菌药物管理标准生效三年之后的结果。结果：767例患者进行了分析（Ñ在2016年和2017年，基准期495 =;n = 272（2018年，抗菌素管理期间）。每100个病人天的总治疗天数从47.0天减少到42.2天（p = 0.035）。与两个时期相比，接受术后治疗的患者比率从56.8％下降至45.2％（p = 0.002）。不当适应症的发生率显着下降（从17.4％降至8.1％，p = 0.015），从广谱到窄谱抗生素的使用也有显着变化（28.8％至6.5％，p≤0.001）用于术后治疗。抗生素使用量的显着下降不会影响临床结果或术后伤口并发症的发生率。结论：通过抗生素管理干预可以显着减少腹腔内感染的术后抗生素使用。识别不适当的适应症仍然是抗菌素管理计划的主要目标。