Facility type affects antibiotic stewardship guideline adherence

A study published in Antimicrobial Resistance & Infection Control found that lower complexity facilities tend to continue antibiotic therapy longer than guidelines recommend.

Researchers conducted a retrospective cohort study including patients at Veterans Health Administration facilities who underwent an outpatient surgical procedure from Oct. 1, 2015 to Sept. 30, 2017. The patients underwent a procedure in one of the five following specialties: general surgery, urology, ophthalmology, ENT and orthopedics. They studied the association between facility complexity and proportion of surgeries not compliant with the guideline to discontinue antimicrobials within 24 hours of incision closure.

Of 153,097 outpatient surgeries, 5 percent involved antibiotic therapy lasting more than 24 hours after surgery. Lower complexity ASC and hospital outpatient departments had higher odds of prolonged antibiotic therapy as compared to complex hospitals.

Additionally, researchers found genitourinary surgeries, such as cystoscopies and cystoureteroscopy with lithotripsy procedures, had the highest rates of prolonged antibiotic therapy and hernia repair, cataract surgeries and laparoscopic cholecystectomies had the lowest rates.

"Increasing pharmacy, antimicrobial stewardship and/or infection prevention resources to promote more evidence-based care may support surgical providers in lower complexity ambulatory surgery centers and hospital outpatient departments in their efforts to improve this facet of patient safety," study authors concluded.

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