Reduction of urinary tract infection and antibiotic use after surgery: A controlled, prospective, befor after intervention study
ABSTRACT Urinary tract infection is the most frequent health care-associated complication. We hypothesized that the implementation of a multifaceted prevention strategy could decrease its incidence after surgery.
In a controlled, prospective, before-after intervention trial with 1328 adult patients scheduled for orthopedic or abdominal surgery, nosocomial infection surveillance was conducted until hospital discharge. A multifaceted intervention including specifically tailored, locally developed guidelines for the prevention of urinary tract infection was implemented for orthopedic surgery patients, and abdominal surgery patients served as control subjects. Infectious and noninfectious complications, adherence to guidelines, and antibiotic use were monitored before and after the intervention and again 2 years later.
The incidence of urinary tract infection decreased from 10.4 to 3.9 episodes per 100 patients in the intervention group (incidence-density ratio, 0.41; 95% CI, 0.20-0.79; P=.004). Adherence to guidelines was 82.2%. Both the frequency and the duration of urinary catheterization decreased following the intervention. Recourse to antibiotic therapy after surgery dropped in the intervention group from 17.9 to 15.6 defined daily doses per 100 patient-days (P<.005) because of a reduced need for the treatment of urinary tract infection (P<.001). Follow-up after 2 years revealed a sustained impact of the strategy and a subsequent low use of antibiotics, consistent with stable adherence to guidelines (80.8%).
A multifaceted prevention strategy can dramatically decrease postoperative urinary tract infection and contribute to the reduction of the overall use of antibiotics after surgery.
- SourceAvailable from: Günter MarggrafIntensivmedizin + Notfallmedizin 04/2010; 47(3):185-207. DOI:10.1007/s00390-010-0169-2
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ABSTRACT: The reasoning that improved hand hygiene compliance contributes to the prevention of health care-associated infections is widely accepted. It is also accepted that high hand hygiene alone cannot impact formidable risk factors, such as older age, immunosuppression, admission to the intensive care unit, longer length of stay, and indwelling devices. When hand hygiene interventions are concurrently undertaken with other routine or special preventive strategies, there is a potential for these concurrent strategies to confound the effect of the hand hygiene program. The result may be an overestimation of the hand hygiene intervention unless the design of the intervention or analysis controls the effect of the potential confounders. Other epidemiologic principles that may also impact the result of a hand hygiene program include failure to consider measurement error of the content of the hand hygiene program and the measurement error of compliance. Some epidemiological errors in hand hygiene programs aimed at reducing health care-associated infections are inherent and not easily controlled. Nevertheless, the inadvertent omission by authors to report these common epidemiological errors, including concurrent infection prevention strategies, suggests to readers that the effect of hand hygiene is greater than the sum of all infection prevention strategies. Worse still, this omission does not assist evidence-based practice.Infection and Drug Resistance 01/2015; 8:7-18. DOI:10.2147/IDR.S62704
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ABSTRACT: The most common site of nosocomial infection, involving more than 400 000 patients in this country annually, is the catheterized urinary tract. These infections cause significant morbidity, prolong hospital stay, increase hospitalization costs, and contribute to mortality caused by Gram-negative septicemia. Strict adherence to appropriate infection control procedures is necessary if the incidence and sequels of catheter-related infections are to be reduced. Based upon current understanding of the epidemiology of nosocomial urinary tract infections, guidelines for the prevention of catheter-associated urinary tract infections are presented.Annals of internal medicine 04/1975; 82(3):386-90. DOI:10.7326/0003-4819-82-3-386 · 16.10 Impact Factor