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- ArticleAçık Erişim2020Hey surgeons! It is time to lead and be a champion in preventing and managing surgical infections!
Sartelli, Massimo; Coccolini, Federico; Abu-Zidan, Fikri M.; Ansaloni, Luca; Bartoli, Stefano; Biffl, Walter; Borghi, Felice; Chouillard, Elie; Cui, Yunfeng; Nascimento, Rafael De Oliveira
Appropriate measures of infection prevention and management are integral to optimal clinical practice and standards of care. Among surgeons, these measures are often over-looked. However, surgeons are at the forefront in preventing and managing infections. Surgeons are responsible for many of the processes of healthcare that impact the risk for surgical site infections and play a key role in their prevention. Surgeons are also at the forefront in managing patients with infections, who often need prompt source control and appropriate antibiotic therapy, and are directly responsible for their outcome. In this context, the direct leadership of surgeons in infection prevention and management is of utmost importance. In order to disseminate worldwide this message, the editorial has been translated into 9 different languages (Arabic, Chinese, French, German, Italian, Portuguese, Spanish, Russian, and Turkish).
RDL Kalıcı Kaydıİncele - Review ArticleAçık Erişim20202020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting
Sartelli, Massimo; Weber, Dieter G.; Kluger, Yoram; Ansaloni, Luca; Coccolini, Federico; Abu-Zidan, Fikri; Augustin, Goran; Ben-Ishay, Offir; Biffl, Walter L.; Bouliaris, Konstantinos
Acute colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of acute left-sided colonic diverticulitis (ALCD) according to the most recent available literature. The update includes recent changes introduced in the management of ALCD. The new update has been further integrated with advances in acute right-sided colonic diverticulitis (ARCD) that is more common than ALCD in select regions of the world.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2020Complete breast autoamputation: Clinical image
Isik, Arda; Isik, Nurten; Kurnaz, Eray
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2020Open abdomen management for severe peritonitis in elderly. Results from the prospective International Register of Open Abdomen (IROA): Cohort study
Rausei, Stefano; Pappalardo, Vincenzo; Ceresoli, Marco; Catena, Fausto; Sartelli, Massimo; Chiarugi, Massimo; Kluger, Yoram; Kirkpatrick, Andrew; Ansaloni, Luca; Coccolini, Federico
Background: Analyzing the data of the International Register of Open Abdomen (IROA), the feasibility of open abdomen treatment has been demonstrated at every age. This new analysis on the IROA database investigates the risk factors for mortality in elderly patients treated with open abdomen for intra-abdominal infection. Methods: Data were derived from the IROA, a prospective observational international cohort study that enrolled patients treated with open abdomen worldwide. A univariate analysis of potential risk factors was performed. Inclusion criteria were patients older than 65 years and treated with open abdomen for intra-abdominal infection. End point was overall mortality, calculated within 30 days after open abdomen management, after 1-month and 1-year follow-up. Results: A total of 116 patients was analyzed with mean age of 76 ± 7 years. Definitive closure was achieved in 93 patients (93/116, 80.2%) for a mean open abdomen duration of 5.0 ± 5.0 days. Complicated patients were 101 (101/116, 87.1%) for a total of 201 complications. Overall, 62 out of 116 patients (53.4%) died: 23 patients (23/62, 37.1%) during open abdomen management, 29 patients (46.8%) within 30 days after abdominal closure, 9 patients (14.5%) after 1-month follow-up, and 1 patient (1.6%) after 1-year follow-up. Age did not affect mortality (75 ± 6 years in alive patients versus 77 ± 7 years in dead patients, p = 0.773). Definitive abdominal closure was the most important factor to prevent mortality. Conclusions: This study confirmed that age alone cannot be considered a determinant for death, even in elderly patients managed with open abdomen for severe intra-abdominal infection.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2020Impact of the SARS-CoV-2 pandemic on emergency surgery services—a multi-national survey among WSES members
Reichert, Martin; Sartelli, Massimo; Weigand, Markus A.; Doppstadt, Christoph; Hecker, Matthias; Reinisch-Liese, Alexander; Bender, Fabienne; Askevold, Ingolf; Padberg, Winfried; Coccolini, Federico
Background: The SARS-CoV-2 pandemic is a major challenge for health care services worldwide. It’s impact on oncologic therapies and elective surgery has been described recently, and the literature provides guidelines regarding appropriate elective patient treatment during the pandemic. However, the impact of SARS-CoV-2 pandemic on emergency surgery services has been poorly investigated up to now. Methods: A 17-item web survey had been distributed to emergency surgeons in June 2020 around the world, investigating the impact of SARS-CoV-2 pandemic on patients and septic diseases both requiring emergency surgery and the time-to-intervention in emergency surgery routine, as well as experiences with surgery in COVID-19 patients. Results: Ninety-eight collaborators from 31 countries responded to the survey. The majority (65.3%) estimated the impact of the SARS-CoV-2 pandemic on emergency surgical patient care as being strong or very strong. Due to the pandemic, 87.8% reported a decrease in the total number of patients undergoing emergency surgery and approximately 25% estimated a delay of more than 2 h in the time-to-diagnosis and another 2 h in the time-to-intervention. Fifty percent make structural problems with in-hospital logistics (e.g. transport of patients, closed normal wards etc.) mainly responsible for delayed emergency surgery and the frequent need (56.1%) for a triage of emergency surgical patients. 56.1% of the collaborators observed more severe septic abdominal diseases during the pandemic, especially for perforated appendicitis and severe septic cholecystitis (41.8% and 40.2%, respectively). 62.2% had experiences with surgery in COVID-19-infected patients. Conclusions: The results of The WSES COVID-19 emergency surgery survey are alarming. The combination of an estimated decrease in numbers of emergency surgical patients and an observed increase in more severe septic diseases may be a result of the fear of patients from infection with COVID-19 and a consecutive delayed hospital admission and diagnosis. A critical delay in time-to-diagnosis and time-to-intervention may be a result of changes in in-hospital logistics and operating room as well as intensive care capacities. Both reflect the potentially harmful impact of SARS-CoV-2 pandemic on emergency surgery services.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2020Open Abdomen and Fluid Instillation in the Septic Abdomen: Results from the IROA Study
Coccolini, Federico; Gubbiotti, Francesca; Ceresoli, Marco; Tartaglia, Dario; Fugazzola, Paola; Ansaloni, Luca; Sartelli, Massimo; Kluger, Yoram; Kirkpatrick, Andrew; Amico, Francesco
Background: Open abdomen (OA) is a surgical option that can be used in patients with severe peritonitis. Few evidences exist to recommend the use of intraperitoneal fluid instillation associated with OA in managing septic abdomen. Materials and methods: A prospective analysis of adult patients enrolled in the International Register of Open Abdomen (trial registration: NCT02382770) was performed. Results: A total of 387 patients were enrolled in two groups: 84 with peritoneal fluid instillation (FI) and 303 without (NFI). The groups were homogeneous for baseline characteristics. Overall complications were 92.9% in FI and 86.3% in NFI (p = 0.106). Complications during OA were 72.6% in FI and 59.9% in NFI (p = 0.034). Complications after definitive closure were 70.8% in FI and 61.1% in NFI (p = 0.133). Entero-atmospheric fistula was 13.1% in FI and 12% in NFI (p = 0.828). Fascial closure was 78.6% in FI and 63.7% in NFI (p = 0.02). Analysis of FI in negative pressure wound therapy (NPWT) showed: Overall morbidity in NPWT was 94% and in non-NPWT 91.2% (p = 0.622) and morbidity during OA was 68% and 79.4% (p = 0.25), respectively. Definitive fascial closure in NPWT was 87.8% and 96.8% in non-NPWT (p = 0.173). Overall mortality was 40% in NPWT and 29.4% in non-NPWT (p = 0.32) and morality during OA period was 18% and 8.8% (p = 0.238), respectively. Conclusion: We found intraperitoneal fluid instillation during open abdomen in peritonitic patients to increase the complication rate during the open abdomen period, with no impact on mortality, entero-atmospheric fistula rate and opening time. Fascial closure rate is increased by instillation. Fluid instillation is feasible even when associated with nonnegative pressure temporary abdominal closure techniques.
RDL Kalıcı Kaydıİncele - Conference ObjectAçık Erişim2019Does Locoregional Treatment in de Novo Stage IV Bone-Only Metastatic Breast Cancer Prolong Survival? An Ongoing Multicenter Registry Study
Soran, Atilla; Isik, Arda; Dogan, Lutfi; Sezgin, Efe; Ozbas, Serdar
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019Open abdomen and entero-atmospheric fistulae: An interim analysis from the International Register of Open Abdomen (IROA)
Coccolini, Federico; Ceresoli, Marco; Kluger, Yoram; Kirkpatrick, Andrew; Montori, Giulia; Salvetti, Fracensco; Fugazzola, Paola; Tomasoni, Matteo; Sartelli, Massimo; Ansaloni, Luca
Introduction: No definitive data describing associations between cases of Open Abdomen (OA) and Entero-atmospheric fistulae (EAF) exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) thus analyzed the International Register of Open Abdomen (IROA) to assess this question. Material and methods: A prospective analysis of adult patients enrolled in the IROA. Results: Among 649 adult patients with OA 58 (8.9%) developed EAF. Indications for OA were peritonitis (51.2%) and traumatic-injury (16.8%). The most frequently utilized temporary abdominal closure techniques were Commercial-NPWT (46.8%) and Bogotà-bag (21.9%). Mean OA days were 7.9 ± 18.22. Overall mortality rate was 29.7%, with EAF having no impact on mortality. Multivariate analysis associated cancer (p = 0.018), days of OA (p = 0.003) and time to provision-of-nutrition (p = 0.016) with EAF occurrence. Conclusion: Entero-atmospheric fistulas are influenced by the duration of open abdomen treatment and by the nutritional status of the patient. Peritonitis, intestinal anastomosis, negative pressure and oral or enteral nutrition were not risk factors for EAF during OA treatment.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019Spontaneous milk fistula from an axillary accessory breast
Isik, Arda; Karavas, Erdal; Firat, Deniz
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: A WSES observational study
Sartelli, Massimo; Abu-Zidan, Fikri M.; Labricciosa, Francesco M.; Kluger, Yoram; Coccolini, Federico; Ansaloni, Luca; Leppäniemi, Ari; Kirkpatrick, Andrew W.; Tolonen, Matti; Tranà, Cristian
Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods: This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8. Conclusions: The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2018Atipik Prezente Kist Hidatik: Pankreas Başında Kitle
Isik, Arda; Yılmaz, İsmayil; Korkmaz, Serdar; Firat, Deniz; Demiryılmaz, İsmail
Echinococcus granulosus, ülkemizde sık görülen, genellikle karaciğerde gözlenen, paraziter bir hastalıktır. 20 yaşında erkek hasta, sağana hepatik kanala açılmış ve buna sekonder pankreas başında koledok dilatasyonuna sebep olan kist hidatik olgusu ile prezente edildi.Kolesistektomi, unroofing ve kist eksizyonu yapılan hasta postoperatif 3. gün taburcu edildi. Kontrol abdominal bilgisayarlı tomografiincelemesinde dilate koledok görüntüsü kaybolan hastanın takiplerinde herhangi bir sorun ile karşılaşılmadı. Kist hidatik, evresine göretedavisi perkütan drenaj veya cerrahi olarak uygulanan, nadirde olsa safra kanallarına açılan ve buna sekonder kolanjit ve pankreas başındakitle ile klinik bulgu verebilen bir hastalıktır. Antijen ve antikor seviyeleri tanı için yardımcı olabilir. Kistin karakteristik özellikleri görüntülemeyöntemleri ile tanımlanarak, tedavi planı her hastaya özel planlanmalıdır. ( Sakarya Tıp Dergisi 2018, 8(1):149-152 )
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2018Breast Skin Necrosis After Methylene Blue Dye İnjection: Breast İmage
Isik, Arda; Yılmaz, İsmayil; Firat, Deniz; İnal, Abdullah; Çelebi, Fehmi; Peker, Kemal
Sentinel lymph node dissection is the gold standard treatment for non-lymph node metastatic breast cancers. Here we present, a 41-yearoldwoman with a BIRADS-5 mass in the left retroareolar area. After sentinel lymph node biopsy, she had breast skin necrosis.( Sakarya Med J 2018, 8(1):153-156 )
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2018Bilateral intra-areolar polythelia
Isik, Arda; Firat, Deniz
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2018A survey of current approaches to thyroid nodules and thyroid operations
Isik, Arda; Firat, Deniz; Yilmaz, Ismayil; Peker, Kemal; Idiz, Oguz; Yilmaz, Bahri; Demiryilmaz, Ismail; Celebi, Fehmi
Introduction: Thyroid nodules are commonly seen. Our aim is to learn the behaviors and operational attitudes of surgeons approaching the thyroid nodules. In a literature search, our study is the first and only study performed merely on surgeons. Materials- Metods: This cross-sectional study was done between June 2014–January 2015. The questionnaire consists of 25 questions. Initially, general questions consisting of demographic findings were asked. In step 2, questions consisting of the index case and case variants were asked. Results were compared with American Thyroid Association, European Thyroid Association guidelines, and Australia survey results. In the last step, questions about thyroid operations were asked. Results: A total of 301 surgeons responded to the survey. The response rate was approximately 20%. Thirty nine were female and 262 were male. For the question that asks the diameter of the thyroid nodule that will require a thyroid fine needle aspiration biopsy (TFNAB), 47.5% of the surgeons will require a TFNAB for 1–2 cm solid nodules. 40.15% of the surgeons required a TFNAB regardless of size. 46.1% of the surgeons who required a TFNAB between 1 and 2 cm solid nodules also required scintigraphy at diagnosis of suppressed TSH case variant. Conclusion: In this survey, we identified differences from up-to-date guidelines about approaching thyroid nodules and perioperative thyroid surgery. From our perspective, surgeons need updated training requirements. This can be done with updated seminars across the country. Thereby approaches may become standard and consequently patients may have qualified services.
RDL Kalıcı Kaydıİncele - Review ArticleAçık Erişim2018Raising concerns about the Sepsis-3 definitions
Sartelli, Massimo; Kluger, Yoram; Ansaloni, Luca; Hardcastle, Timothy C.; Rello, Jordi; Watkins, Richard R.; Bassetti, Matteo; Giamarellou, Eleni; Coccolini, Federico; Abu-Zidan, Fikri M.
The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2018Prospective Observational Study on acute Appendicitis Worldwide (POSAW)
Sartelli, Massimo; Baiocchi, Gian L.; Di Saverio, Salomone; Ferrara, Francesco; Labricciosa, Francesco M.; Ansaloni, Luca; Coccolini, Federico; Vijayan, Deepak; Abbas, Ashraf; Abongwa, Hariscine K.
Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%. Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2017Correlation of Bowel Wall Thickening Seen Using Computerized Tomography With Colonoscopies: A Preliminary Study
Isik, Arda; Soyturk, Mehmet; Süleyman, Sakir; Firat, Deniz; Peker, Kemal; Yilmaz, Ismayil; Celebi, Fehmi
Purpose: Bowel wall thickening (BWT) is a common finding in abdominal computerized tomography imaging (CTi). The purpose of the present study was a prospective assessment and management of patients who have BWT in abdominal CTi. Materials and Methods: This study was conducted between January 2012 and July 2014 at Erzincan University Hospital, Turkey, with 64 patients who were admitted to the emergency and general surgery department. All of the patients had received colonoscopies due to BWT seen in abdominal CTi. Results: Twenty-three (36%) female and 41 (64%) male patients were included in the study. The mean age was 56.2 years (range, 14 to 84 y). The positive predictive value of CTi for BWT was 87.5%. The positive predictive value of a CTi diagnosis of the disease according to a radiologist's report was 78.1%. Common pathologies detected by colonoscopy included neoplasia and inflammatory bowel disease. Conclusions: Diagnosis of BWT by abdominal CTi reveals pathologies in many cases. Colonoscopies will be helpful in the differential diagnosis.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2017IROA: International Register of Open Abdomen, preliminary results
Coccolini, Federico; Montori, Giulia; Ceresoli, Marco; Catena, Fausto; Ivatury, Rao; Sugrue, Michael; Sartelli, Massimo; Fugazzola, Paola; Corbella, Davide; Salvetti, Francesco
Background: No definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA). Methods: A prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers®) through a dedicated website: www.clinicalregisters.org. Results: Four hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39±18.37; 56% male; Mean BMI: 36±5.6. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%),Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(±4.83) days; Mean number of dressing changes: 0.88(±0.88). After-closure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p<0.0001) and with the fistula development (Pearson = 0.146 p= 0.016). Pediatric patients: 33 patients. Mean age: 5.91±(3.68) years; 60% male. Mortality: 3.4%; Complications: 44.8%; Fistula: 3.4%. Mean duration of OA: 3.22(±3.09) days. Conclusion: Temporary abdominal closure is reliable and safe. The different techniques account for different results according to the different indications. In peritonitis commercial negative pressure temporary closure seems to improve results. In trauma skin-closure and Bogotà-bag seem to improve results. Trial registration: ClinicalTrials.gov NCT02382770
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2017Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery
Parisi, Amilcare; Reim, Daniel; Borghi, Felice; Nguyen, Ninh T.; Qi, Feng; Coratti, Andrea; Cianchi, Fabio; Cesari, Maurizio; Bazzocchi, Francesca; Alimoglu, Orhan
AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes. METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy (RG), laparoscopic gastrectomy (LG), open gastrectomy (OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided. RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients (RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery (P = 0.42) and stage of the disease (P = 0.16). Intraoperative blood loss was significantly lower in the LG (95.93 ± 119.22) and RG (117.91 ± 68.11) groups compared to the OG (127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG (27.78 ± 11.45), LG (24.58 ± 13.56) and OG (25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay (P < 0.0001). A similar complications rate was found (P = 0.13). The leakage rate was not different (P = 0.78) between groups. CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2017The Global Alliance for Infections in Surgery: Defining a model for antimicrobial stewardship-results from an international cross-sectional survey
Sartelli, Massimo; Labricciosa, Francesco M.; Barbadoro, Pamela; Pagani, Leonardo; Ansaloni, Luca; Brink, Adrian J.; Carlet, Jean; Khanna, Ashish; Chichom-Mefire, Alain; Coccolini, Federico
Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.
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