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      Assessment of implementation of antibiotic stewardship program in surgical prophylaxis at a secondary care hospital in Ras Al Khaimah, United Arab Emirates

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          Abstract

          Antibiotic overuse is a major factor for causing antibiotic resistance globally. However, only few studies reported the implementation and evaluation of antimicrobial stewardship programs in Gulf Cooperation Council. This study was conducted within 8-months periods to evaluate the effect of the newly implemented antibiotic stewardship program on improving the prescribing practice of surgical antibiotic prophylaxis in a secondary care hospital in the United Arab Emirates by releasing local hospital guidelines. The data of 493 in patients were documented in the predesigned patient profile form and the prescribing practice of surgical antibiotic prophylaxis for clean and clean-contaminant surgical procedures was compared and analyzed two months’ prior (period A) and post (period B) the implementation of antibiotic stewardship program. The 347 patient’s data (PD) were analyzed during period A and 146 PD during period B. The prescription of piperacillin/tazobactam was decreased from 2.4% from all surgical prophylaxis antibiotic orders in period A to 0% in period B. The appropriateness of the antibiotic therapy was found to differ non significantly for the selection of prophylactic antibiotic ( p = 0.552) and for the timing of first dose administration ( p = 0.061) between A and B periods. The total compliance was decreased non significantly ( P = 0.08) from 45.3 to 40.2%. Overall, the guidelines have improved the prescribing practice of antibiotics prior to surgery. However, further improvement can be achieved by initiating educational intervention via cyclic auditing strategy.

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          Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship.

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            The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection.

            Randomized, controlled trials have shown that prophylactic antibiotics are effective in preventing surgical-wound infections. However, it is uncertain how the timing of antibiotic administration affects the risk of surgical-wound infection in actual clinical practice. We prospectively monitored the timing of antibiotic prophylaxis and studied the occurrence of surgical-wound infections in 2847 patients undergoing elective clean or "clean-contaminated" surgical procedures at a large community hospital. The administration of antibiotics 2 to 24 hours before the surgical incision was defined as early; that during the 2 hours before the incision, as preoperative; that during the 3 hours after the incision, as perioperative; and that more than 3 but less than 24 hours after the incision, as postoperative. Of the 1708 patients who received the prophylactic antibiotics preoperatively, 10 (0.6 percent) subsequently had surgical-wound infections. Of the 282 patients who received the antibiotics perioperatively, 4 (1.4 percent) had such infections (P = 0.12; relative risk as compared with the preoperatively treated group, 2.4; 95 percent confidence interval, 0.9 to 7.9). Of 488 patients who received the antibiotics postoperatively, 16 (3.3 percent) had wound infections (P less than 0.0001; relative risk, 5.8; 95 percent confidence interval, 2.6 to 12.3). Finally, of 369 patients who had antibiotics administered early, 14 (3.8 percent) had wound infections (P less than 0.0001; relative risk, 6.7; 95 percent confidence interval, 2.9 to 14.7). Stepwise logistic-regression analysis confirmed that the administration of antibiotics in the preoperative period was associated with the lowest risk of surgical-wound infection. We conclude that in surgical practice there is considerable variation in the timing of prophylactic administration of antibiotics and that administration in the two hours before surgery reduces the risk of wound infection.
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              Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention.

              The proven benefits of antibiotic stewardship programs (ASPs) for optimizing antibiotic use and minimizing adverse events, such as Clostridium difficile and antibiotic resistance, have prompted the Centers for Disease Control and Prevention (CDC) to recommend that all hospitals have an ASP. This article summarizes Core Elements of Hospital Antibiotic Stewardship Programs, a recently released CDC document focused on defining the infrastructure and practices of coordinated multidisciplinary programs to improve antibiotic use and patient care in US hospitals.
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                Author and article information

                Contributors
                areeganwer@rakmhsu.ac.ae
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                13 January 2021
                13 January 2021
                2021
                : 11
                : 1042
                Affiliations
                [1 ]GRID grid.449450.8, ISNI 0000 0004 1763 2047, Department of Clinical Pharmacy and Pharmacology, Rak College of Pharmaceutical Sciences, , RAK Medical and Health Sciences University, ; Ras Al Khaimah, United Arab Emirates
                [2 ]GRID grid.415786.9, ISNI 0000 0004 1773 3198, Pharmacy Department, , Saqr Hospital, Ministry of Health and Prevention, ; Ras Al Khaimah, United Arab Emirates
                [3 ]GRID grid.415786.9, ISNI 0000 0004 1773 3198, Anesthesia Department, , Saqr Hospital, Ministry of Health and Prevention, ; Ras Al Khaimah, United Arab Emirates
                [4 ]GRID grid.415786.9, ISNI 0000 0004 1773 3198, Surgical Department, , Saqr Hospital, Ministry of Health and Prevention, ; Ras Al Khaimah, United Arab Emirates
                [5 ]Pure Health Company, Dubai, United Arab Emirates
                [6 ]GRID grid.415786.9, ISNI 0000 0004 1773 3198, Pediatric Department, , Saqr Hospital, Ministry of Health and Prevention, ; Ras Al Khaimah, United Arab Emirates
                [7 ]GRID grid.415786.9, ISNI 0000 0004 1773 3198, Present Address: Pharmacy Department, Abdullah Bin Omran Hospital for Obstetrics & Gynecology, , Ministry of Health and Prevention, ; Ras Al Khaimah, United Arab Emirates
                Article
                80219
                10.1038/s41598-020-80219-y
                7806636
                33441843
                edbf99cc-4c36-4066-be9d-b1f32ea60c73
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 14 August 2020
                : 17 December 2020
                Categories
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                © The Author(s) 2021

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                diseases,health care,medical research
                Uncategorized
                diseases, health care, medical research

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