27 Reduction of the duration of antibiotic therapy in surgery through a specific nationwide stewardship program. A prospective cohort study (2019–2022)

Abstract Aim Prolonged antibiotic treatments contribute to increasing antimicrobial resistance. Current guidelines recommend 5–7 days of treatment in patients with surgical infection with an adequate source control. Antibiotic stewardship aim to optimize the use of antibiotics, including their duration. The 7VINCut nationwide intervention aims to reduce the duration of treatments to <7 days in surgical patients. Methods Prospective cohort study conducted in 37 hospitals in 2019–2022. Patients admitted to surgical services with antibiotic treatment >7 days were analysed. The 7VINCut teams met weekly and made written recommendations in the electronic medical record. Indication for treatment, quality of source control, type of antibiotics, recommendations issued, and adherence to them were analysed. Temporal trends in the percentages of patients admitted with antibiotic treatment and those with treatment >7 days were evaluated using a linear regression model and Pearson's correlation coefficients. Results 44 702 patients with antibiotic treatment were examined. Of these, 6163 (13.8%) had treatments >7 days. A total of 5606 stewardship interventions were performed (90% of the target population), primarily in general surgery (5704; 90%) and urology (497; 8.9%). The main sources of infection were intra-abdominal (73%), skin/soft tissues (10%) and urinary (9.3%). The septic focus was considered controlled only in 60.2% of cases. Out of 6236 antibiotic prescriptions, the most frequently analysed drugs were piperacillin/tazobactam (27.1%), metronizadole (14.4%), amoxicillin/clavulanate (12.9%), meropenem (12.8%), ceftriaxone (11.6%) and ciprofloxacin (8.1%). Antibiotics with a high ecological impact account for 68.3% of the prescriptions evaluated. The main issued recommendations were: treatment discontinuation (34.1%), maintenance (41.0%) or de-escalation (15.3%), and were followed in 5179 cases (adherence 92.4%). With an adequate source control, the most frequent recommendation was to terminate treatment (49.6%, 1673 cases). Throughout the study period, a significant decrease in the percentage of prolonged treatments was observed (−40.1%, Pc = −0.39; P = 0.006). Conclusions The 7VINCut program, including surgeons in the multidisciplinary antibiotic stewardship teams, achieved a reduction in antibiotic treatments lasting over 7 days in surgical departments. The majority of stewardship interventions were carried out in general surgery departments, in cases of intra-abdominal infection and in beta-lactam and carbapenem antibiotics. Overall adherence to the recommendations issued by the teams was 92.4%.