aalaa afdal m. saber - global pps · 2020. 7. 1. · guidelines missing 72 (68 a - 4 p) 15.2...
TRANSCRIPT
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Prophylactic Antimicrobial Use for
Surgical Procedures in Egypt
Aalaa Afdal M. SaberBSc., MSc, BCPS, ASP pharmacist
MPA candidate – AUC09-07-2018
09/07/2018Prophylactic Antimicrobial Use for Surgical
Procedures in Egypt - Aalaa Afdal1
Rational Drug Use Department
Hospital Pharmacy Administration
Central Administration for pharmaceutical
Affairs – Ministry of Health
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The Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS):
Prophylactic Antimicrobial Use for Surgical Procedures in Egypt.
Aalaa Afdal1, Raghda Shehab El-Din1, Ann Versporten2
Soaad Abdelalim1, Safa Hassan Nada1, Herman Goossens2
1Ministry Of Health, Cairo, Egypt; 2Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute,
University of Antwerp, Antwerp, Belgium.
Authors
09/07/2018Prophylactic Antimicrobial Use for Surgical
Procedures in Egypt - Aalaa Afdal2
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Content
Background
Methods
Results
Conclusion
Acknowledgments
Africa
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Procedures in Egypt - Aalaa Afdal3
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The pattern of antimicrobial use for surgical prophylaxis is Not well recognized in Egypt.
Background
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Procedures in Egypt - Aalaa Afdal4
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The Global Point Prevalence Survey of Antimicrobial Consumption and
Resistance (GLOBAL-PPS) is a well-known and validated project collecting data to
monitor rates of antimicrobial prescribing in hospitalised patients.
Background
09/07/2018Prophylactic Antimicrobial Use for Surgical
Procedures in Egypt - Aalaa Afdal5
G-PPS provide an easy and yet a very useful tool to assess AMC and AMR
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Methods
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Procedures in Egypt - Aalaa Afdal6
Web based app.
Data entry
validation
reporting
analysis
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Method
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Procedures in Egypt - Aalaa Afdal7
A uniform and standardized method for surveillance of surgical prophylactic antimicrobial use in hospitals
was used to assess the variation in the prescribing habit of surgical prophylaxis in order to identify
possible improvement strategies in this area.
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Methods
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Procedures in Egypt - Aalaa Afdal8
All patients receiving at
least 1 antimicrobial
Conducted in different sectors in different
governorates
May – July 2017
(17 hospitals)
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Results
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Procedures in Egypt - Aalaa Afdal9
418 Antimicrobials
276
patients14 Hospitals
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Surgical procedures surveyed
UTI prophylaxis for adults and children
Plastic and orthopedic surgery in adults and children
GI prophylaxis in adults and children
Obstetric or gynecological prophylaxis in adult wards
CNS prophylaxis in adults and children
Methods
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Procedures in Egypt - Aalaa Afdal10
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Results
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Procedures in Egypt - Aalaa Afdal11
The duration of surgical prophylactic
antimicrobial use of different surgeries in EgyptPercentage %
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Results
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Prophylactic Antimicrobials
N=616 AB
Surgical
N=418 (67.9%)
Medical
N=198 (32.1%)
276 patients
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Results
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Procedures in Egypt - Aalaa Afdal13
Penicillins51%
Other B-lactams21%
Sulfonamides and Trimethoprim
1%
Aminoglycosides3%
Quinolones3%
others21%
Overall proportional antibiotic use for surgical patients
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Results
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Procedures in Egypt - Aalaa Afdal14
Ceftriaxone21%
IV Metronidazole
16% Amox. + Clav.15% Cefotaxime
14%
Amp. + Sulb.9%
0%
5%
10%
15%
20%
25%
Ceftriaxone IV Metronidazole Amox. + Clav. Cefotaxime Amp. + Sulb.
Top 5 antimicrobials for surgical prophylaxis
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Results
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33%
20% 19%
10% 10%
0%
5%
10%
15%
20%
25%
30%
35%
IV Metronidazole Cefotaxime Ceftriaxone Cefoxitin Cefoperazonecombinations
Top antimicrobials used for GI surgical prophylaxis
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Results
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Procedures in Egypt - Aalaa Afdal16
Unnecessary double coverage for anaerobes.
Clinical practice guidelines for antimicrobial prophylaxis in surgery
(ASHP report)
Dale W. Bratzler, E. Patchen Dellinger, Keith M. Olsen, Trish M. Perl, Paul G. Auwaerter, Maureen K. Bolon, Douglas N. Fish, Lena M. Napolitano, Robert
G. Sawyer, Douglas Slain, James P. Steinberg, and Robert A. Weinstein
Am J Health-Syst Pharm. 2013; 70:195-283
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Results
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Procedures in Egypt - Aalaa Afdal17
35%
8%
32%
10%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Ceftriaxone Cefepime Cefoperazonecombination
Amp. + Sulb.
Top antimicrobials used for UTI surgical prophylaxis
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Results
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Procedures in Egypt - Aalaa Afdal18
Broad spectrum antibiotics
Clinical practice guidelines for antimicrobial prophylaxis in surgery
(ASHP report)
Dale W. Bratzler, E. Patchen Dellinger, Keith M. Olsen, Trish M. Perl, Paul G. Auwaerter, Maureen K. Bolon, Douglas N. Fish, Lena M. Napolitano, Robert
G. Sawyer, Douglas Slain, James P. Steinberg, and Robert A. Weinstein
Am J Health-Syst Pharm. 2013; 70:195-283
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Summary for quality indicators in surgical wards:
• For reason in notes and stop/review date documented: Count at
antibacterial level. (418 antimicrobials)
• For guidelines missing: Count on NA (= no local guidelines for the specific
indication) at patient level and diagnosis over total scores for this indicator.
• For guideline compliance: Count at patient level and diagnosis for
compliance = yes or no only. (276 patients)
• For combination therapy with >1 antibiotic: if 1 antibiotic by diagnosis is
not compliant, this combination therapy as a whole for this diagnosis will be
counted as non−compliant.
Indicator N %
Reasons in notes 232 (213 A - 19 P) 55.5
Guidelines missing 72 (68 A - 4 P) 15.2
Guidelines compliant 107 (99 A - 8 P) 41.5
Stop/review date documentation 82 (76 A - 6P) 17.3
Results
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IV therapy
293 (92.7%)
Multiple AB diagnosis
147 (47 %)
Multiple AB patients
150 (48.9%)
Results
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Procedures in Egypt - Aalaa Afdal20
Key prescription patterns (Analyses at patient level).
• Multiple ATB diagnosis
is defined as receiving >
1 antibiotic (J01) for a
single identified reason to
treat (=diagnose code) at
patient level.
• Multiple ATB patient is
defined as receiving > 1
antibiotic (J01) at patient
level.
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The Global-PPS tool allowed us to assess different areas where surgical prophylactic antimicrobial use were irrationally prescribed.
The duration of surgical prophylactic antimicrobial use of more than one day and multiple antimicrobial agents prescribing are the top identified priority problems for surgical prophylaxis in Egypt.
Implementation of antimicrobial stewardship program is highly recommended in order to rationalize the use of antimicrobials in Egypt, especially for surgical prophylaxis.
Conclusion
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• The Global-PPStool was verybeneficial to settargets and werecommend toconduct itperiodically inorder to followup interventionsthat have beentaken.
Conclusion
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1. Head of Hospital Pharmacy Administration.2. Rational drug use department team. 3. Laboratory of Medical Microbiology, Vaccine and Infectious
Diseases Institute, University of Antwerp, Antwerp, Belgium; 4. All healthcare professionals who helped us to conduct the
survey and collect data.
Sponsor:
BioMérieux is the sole sponsor of the GLOBAL Point Prevalence Survey.
Acknowledgements
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Procedures in Egypt - Aalaa Afdal23
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Disclosures
“BioMérieux is the sole private sponsor of the GLOBAL Point Prevalence Survey. The Global-PPS is also funded by a personal
Methusalem grant to Herman Goossens of the Flemish government. The funder has no role in study design, data collection, data analysis,
data interpretation, or writing the report. Data are strictly confidential and stored anonymous at the coordinating
center of the University of Antwerp.”
09/07/2018Prophylactic Antimicrobial Use for Surgical
Procedures in Egypt - Aalaa Afdal
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