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Opportunities for system level improvement in antibiotic use across the surgical pathway

Charani, E; Ahmad, R; Tarrant, C; Birgand, G; Leather, A; Mendelson, M; Moonesinghe, SR; ... Holmes, A; + view all (2017) Opportunities for system level improvement in antibiotic use across the surgical pathway. International Journal of Infectious Diseases , 60 pp. 29-34. 10.1016/j.ijid.2017.04.020. Green open access

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Abstract

Optimizing antibiotic prescribing across the surgical pathway (before, during, and after surgery) is a key aspect of tackling important drivers of antimicrobial resistance and simultaneously decreasing the burden of infection at the global level. In the UK alone, 10 million patients undergo surgery every year, which is equivalent to 60% of the annual hospital admissions having a surgical intervention. The overwhelming majority of surgical procedures require effectively limited delivery of antibiotic prophylaxis to prevent infections. Evidence from around the world indicates that antibiotics for surgical prophylaxis are administered ineffectively, or are extended for an inappropriate duration of time postoperatively. Ineffective antibiotic prophylaxis can contribute to the development of surgical site infections (SSIs), which represent a significant global burden of disease. The World Health Organization estimates SSI rates of up to 50% in postoperative surgical patients (depending on the type of surgery), with a particular problem in low- and middle-income countries, where SSIs are the most frequently reported healthcare-associated infections. Across European hospitals, SSIs alone comprise 19.6% of all healthcare-acquired infections. Much of the scientific research in infection management in surgery is related to infection prevention and control in the operating room, surgical prophylaxis, and the management of SSIs, with many studies focusing on infection within the 30-day postoperative period. However it is important to note that SSIs represent only one of the many types of infection that can occur postoperatively. This article provides an overview of the surgical pathway and considers infection management and antibiotic prescribing at each step of the pathway. The aim was to identify the implications for research and opportunities for system improvement.

Type: Article
Title: Opportunities for system level improvement in antibiotic use across the surgical pathway
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ijid.2017.04.020
Publisher version: https://doi.org/10.1016/j.ijid.2017.04.020
Language: English
Additional information: © 2017 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords: Science & Technology, Life Sciences & Biomedicine, Infectious Diseases, Surgery, Infection, Antibiotic Prescribing, Low And Middle Income Countries, Care-Associated Infections, Urinary-Tract-Infection, Site Infection, Risk-Factors, Postoperative Pneumonia, Safety Checklists, Enhanced-Recovery, Operating-Room, Surgery, Outcomes
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/10054238
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