Antimicrobial Stewardship Intervention in Vascular Surgery

Prospective audit and feedback. For every patient hospitalised for at least 48 h and receiving at least one antibiotic and/or antifungal drug for therapeutic purposes during the intervention activity, a revision of the antimicrobial prescription was conducted through an active discussion among the two ID consultants and a resident or a senior surgeon, resulting in a written consultation included in the medical record of the patient. Each evaluation considered the clinical picture, blood tests, radiological exams and microbiological results. Antimicrobials prescribed for surgical prophylaxis were not revised. Decisions on the prescriptions were coded as follows: Antimicrobials not recommended; Stop antimicrobials; De-escalate antimicrobials (by switching from parenteral to oral, narrowing the spectrum of activity or reducing the number of drugs administered); Change antimicrobials; Change dosage of antimicrobials; Continue antimicrobials; Start antimicrobials; Escalate antimicrobials (by switching from oral to parenteral, broadening the spectrum of activity, increasing the number of drugs administered).

Educational meetings about antimicrobial stewardship and infection control. During Period B, monthly meetings were organized by the ID consultants to increase knowledge about AMR, hospital-acquired infections and infection control. Particularly, the consultants showed both medical and non-medical healthcare workers staff (i.e., nurses and auxiliary staff), the basic principles of patient contact isolation, cohorting, hand hygiene and the use of personal protection equipment (PPE) in case of patients either colonized or infected with MDRO or Clostridioides difficile.