Background and importance The aim of antimicrobial stewardship programmes (AMS) is to improve clinical outcomes, minimise associated adverse events and avoid the potential emergence of resistance. The General Surgery Service (GSS), given its complexity, heterogeneity and need to treat varied and complex infections, is a service potentially benefitting from these interventions.
Aim and objectives Our objective was to analyse the recommendations issued by the pharmacist and evaluate the degree of acceptance by surgeons.
Material and methods A prospective study was carried out between February and April 2021. Patients with antimicrobial treatment for ≥4 days were included. Recommendations were: duration of treatment, dosage optimisation, early sequential therapy (EST) (at 72 hours if clinical stability criteria, availability of oral route and existence of antimicrobial for oral administration). Recommendations were made after reviewing the clinical course and microbiological data. They were considered accepted if the prescription was modified after 24 hours. The variables were: gender, age, previous intensive care unit (ICU) stay and initiation of treatment, isolated microorganism, empirical versus targeted treatment, drug, recommendation category and their acceptance, mean of days from discontinuation of treatment to discharge and need to restart antimicrobial therapy at 7 days.
Results 75 recommendations were made. 58 patients were included with a mean age of 69 (SD 15.8) years and 58.7% men. 36% were admitted from the ICU where antimicrobial treatment was started in 66.8%. The most frequent microorganisms were Escherichia coli (13.4%), Enterobacter cloacae (10.4%) and Enteroccocus faecium (8.9%). Treatment was empirical in 68%. Recommendations were: duration of treatment (84%), EST (9.3%), dosage optimisation (6.7%). 66.6% of them were accepted. Most drugs prescribed were: piperacillin/tazobactam (34.7%), amoxicillin/clavulanic acid (16.0%), meropenem (13.3%). Mean of 5 days from discontinuation of treatment to discharge. Need to restart antimicrobial therapy at 7 days (4%).
Conclusion and relevance The duration of antimicrobial therapy was one of the main reasons for inappropriate use in the GSS. A third of patients came from the ICU. All of these make the participation of the pharmacist as a cornerstone of ASP essential. Recommendations were well accepted; however, periodic communication between pharmacists and physicians could be a strategy to optimise treatment, improving efficiency and security.
Conflict of interest No conflict of interest
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