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The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Sartelli M 1 , Labricciosa FM 2 , Barbadoro P 2 , Pagani L 3 , Ansaloni L 4 , Brink AJ 5 Show all authors , Carlet J 6 , Khanna A 7 , Chichom-Mefire A 8 , Coccolini F 9 , Di Saverio S 10 , May AK 11 , Viale P 12 , Watkins RR 13 , Scudeller L 14 , Abbo LM 15 , Abu-Zidan FM 16 , Adesunkanmi AK 17 , Al-Dahir S 18 , Al-Hasan MN 19 , Alis H 20 , Alves C 21 , Araujo da Silva AR 22 , Augustin G 23 , Bala M 24 , Barie PS 25 , Beltrán MA 26 , Bhangu A 27 , Bouchra B 28 , Brecher SM 29 , Caínzos MA 30 , Camacho-Ortiz A 31 , Catani M 32 , Chandy SJ 33 , Jusoh AC 34 , Cherry-Bukowiec JR 35 , Chiara O 36 , Colak E 37 , Cornely OA 38 , Cui Y 39 , Demetrashvili Z 40 , De Simone B 41 , De Waele JJ 42 , Dhingra S 43 , Di Marzo F 44 , Dogjani A 45 , Dorj G 46 , Dortet L 47 , Duane TM 48 , Elmangory MM 49 , Enani MA 50 , Ferrada P 51 , Esteban Foianini J 52 , Gachabayov M 53 , Gandhi C 54 , Ghnnam WM 55 , Giamarellou H 56 , Gkiokas G 57 , Gomi H 58 , Goranovic T 59 , Griffiths EA 60 , Guerra Gronerth RI 61 , Haidamus Monteiro JC 62 , Hardcastle TC 63 , Hecker A 64 , Hodonou AM 65 , Ioannidis O 66 , Isik A 67 , Iskandar KA 68 , Kafil HS 69 , Kanj SS 70 , Kaplan LJ 71 , Kapoor G 72 , Karamarkovic AR 73 , Kenig J 74 , Kerschaever I 75 , Khamis F 76 , Khokha V 77 , Kiguba R 78 , Kim HB 79 , Ko WC 80 , Koike K 81 , Kozlovska I 82 , Kumar A 83 , Lagunes L 84 , Latifi R 85 , Lee JG 86 , Lee YR 87 , Leppäniemi A 88 , Li Y 89 , Liang SY 90 , Lowman W 91 , Machain GM 92 , Maegele M 93 , Major P 94 , Malama S 95 , Manzano-Nunez R 96 , Marinis A 97 , Martinez Casas I 98 , Marwah S 99 , Maseda E 100 , McFarlane ME 101 , Memish Z 102 , Mertz D 103 , Mesina C 104 , Mishra SK 105 , Moore EE 106 , Munyika A 107 , Mylonakis E 108 , Napolitano L 109 , Negoi I 110 , Nestorovic MD 111 , Nicolau DP 112 , Omari AH 113 , Ordonez CA 114 , Paiva JA 115 , Pant ND 116 , Parreira JG 117 , Pędziwiatr M 118 , Pereira BM 119 , Ponce-de-Leon A 120 , Poulakou G 121 , Preller J 122 , Pulcini C 123 , Pupelis G 124 , Quiodettis M 125 , Rawson TM 126 , Reis T 127 , Rems M 128 , Rizoli S 129 , Roberts J 130 , Pereira NR 21 , Rodríguez-Baño J 131 , Sakakushev B 132 , Sanders J 133 , Santos N 134 , Sato N 135 , Sawyer RG 136 , Scarpelini S 137 , Scoccia L 138 , Shafiq N 139 , Shelat V 140 , Sifri CD 141 , Siribumrungwong B 142 , Søreide K 143 , Soto R 144 , de Souza HP 145 , Talving P 146 , Trung NT 147 , Tessier JM 148 , Tumbarello M 149 , Ulrych J 150 , Uranues S 151 , Van Goor H 152 , Vereczkei A 153 , Wagenlehner F 154 , Xiao Y 155 , Yuan KC 156 , Wechsler-Fördös A 157 , Zahar JR 158 , Zakrison TL 159 , Zuckerbraun B 160 , Zuidema WP 161 , Catena F 162

Affiliations 

  • 1 Department of Surgery, Macerata Hospital, Macerata, Italy
  • 2 Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
  • 3 Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
  • 4 General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
  • 5 Department of Clinical microbiology, Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa
  • 6 World Alliance against Antibiotics Resistance, Rome, Italy
  • 7 Center for Critical Care, Anaesthesiology Institute and Department of Outcomes Research, Cleveland Clinic, Cleveland, OH USA
  • 8 Department of Surgery and Obstetrics/Gynaecology, Regional Hospital, Limbe, Cameroon
  • 9 Department of Surgery, Infermi Hospital, Rimini, Italy
  • 10 Department of Surgery, Maggiore Hospital, Bologna, Italy
  • 11 Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee USA
  • 12 Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
  • 13 Division of Infectious Diseases, Cleveland Clinic Akron General, Akron, OH USA
  • 14 Clinical Epidemiology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
  • 15 Division of Infectious Diseases, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL USA
  • 16 Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
  • 17 Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
  • 18 Division of Clinical and Administrative Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA USA
  • 19 Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC USA
  • 20 General Surgery Department, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Instanbul, Turkey
  • 21 Unit of Prevention and Infection Control, Center of Hospital Epidemiology, São João Hospital Centre, Porto, Portugal
  • 22 Infection Control Committee, Prontobaby Hospital da Criança, Rio de Janeiro, Brazil
  • 23 Department of Surgery, University Hospital Center, Zagreb, Croatia
  • 24 Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
  • 25 Department of Surgery, Weill Cornell Medicine, New York, NY USA
  • 26 Department of General Surgery, Hospital San Juan de Dios de La Serena, La Serena, Chile
  • 27 Academic Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK
  • 28 Department of Microbiology National Reference Laboratory Cheikh Khalifa Ibn Zaid Hospital, Mohammed 6th University of Health Sciences, Casablanca, Morocco
  • 29 Department of Pathology and Laboratory Medicine, VA Boston HealthCare System, Boston, MA USA
  • 30 Department of Surgery, Hospital Clínico Universitario, Santiago de Compostela, Spain
  • 31 Hospital Epidemiology and Infectious Diseases, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Mexico
  • 32 Department of Emergency, Umberto I Hospital, Rome, Italy
  • 33 Department of Pharmacology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala India
  • 34 Department of General Surgery, Kuala Krai Hospital, Kuala Krai, Kelantan Malaysia
  • 35 Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI USA
  • 36 Niguarda Hospital, Milano, Italy
  • 37 Department of General Surgery, Health Sciences University, Samsun Training and Research Hospital, Samsun, Turkey
  • 38 Department of Internal Medicine and Infectious Diseases, University of Cologne, Cologne, Germany
  • 39 Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
  • 40 Department General Surgery, Kipshidze Central University Hospital, Tbilisi, Georgia
  • 41 Department of Digestive Surgery, Cannes Hospital, Cannes, France
  • 42 Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
  • 43 School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
  • 44 Department of Surgery, Versilia Hospita, Lido di Camaiore, Italy
  • 45 Department of Surgery, University Hospital of Trauma, Tirana, Albania
  • 46 School of Pharmacy and Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
  • 47 Department of Microbiology, Bicêtre Hospital, Paris-Sud University, La Kremlin-Bicêtre, France
  • 48 Department of Surgery, John Peter Smith Health Network, Fort Worth, Texas USA
  • 49 Sudan National Public Health Laboratory, Federal Ministry of Health, Khartoum, Sudan
  • 50 Department of Medicine, Infectious Disease Division, King Fahad Medical City, Riyadh, Saudi Arabia
  • 51 Department of Surgery, Virginia Commonwealth University, Richmond, VA USA
  • 52 Department of Surgery, Clinica Foianini, Santa Cruz, Bolivia
  • 53 Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
  • 54 Department of Surgery, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra India
  • 55 Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • 56 Sixth Department of Internal Medicine, Hygeia General Hospital, Athens, Greece
  • 57 Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
  • 58 Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Mito, Ibaraki Japan
  • 59 University Department for Tumours, Sestre Milosrrdnice UHC, Zagreb, Croatia
  • 60 General and Upper GI Surgery, Queen Elizabeth Hospital, Birmingham, UK
  • 61 Peruvian Navy Medical Center, Lima, Peru
  • 62 Department of Gastrointestinal Surgery, Santa Casa Hospital, Campo Grande, Brazil
  • 63 Trauma and Trauma ICU, Inkosi Albert Luthuli Central Hospital and Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
  • 64 Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany
  • 65 Department of Surgery, Faculty of Medicine, University of Parakou, BP 123 Parakou, Benin
  • 66 Fourth Surgical Department, General Hospital G. Papanikolaou, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • 67 Department of General Surgery, Erzincan University, Faculty of Medicine, Erzincan, Turkey
  • 68 Department of Pharmacy, Lebanese, International University, Beirut, Lebanon
  • 69 Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  • 70 Division of Infectious Diseases, American University of Beirut, Beirut, Lebanon
  • 71 Department of Surgery Philadelphia VA Medical Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
  • 72 Department of Microbiology, Gandhi Medical College, Bhopal, India
  • 73 Clinic for Emergency Surgery, Medical Faculty University of Belgrade, Belgrade, Serbia
  • 74 Third Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
  • 75 Department of Abdominal Surgery, Regional Hospital of Tienen, Tienen, Belgium
  • 76 Department of Internal Medicine, Royal Hospital, Muscat, Oman
  • 77 Department of Emergency Surgery, City Hospital, Mozyr, Belarus
  • 78 Department of Pharmacology and Therapeutics, College of Health Sciences, Makerere University, Kampala, Uganda
  • 79 Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  • 80 Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
  • 81 Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
  • 82 Department of Surgery n. 2, Higher educational institutions of Ukraine Bukovina State Medical University, Chernivtci City, Ukraine
  • 83 Section of Critical Care Medicine and Section of Infectious Diseases, Department of Medicine, Medical Microbiology and Pharmacology/Therapeutics, University of Manitoba, Winnipeg, MB Canada
  • 84 Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico
  • 85 Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ USA
  • 86 Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
  • 87 Texas Tech University, Health Sciences Center School of Pharmacy, Abilene, TX USA
  • 88 Abdominal Center, University Hospital Meilahti, Helsinki, Finland
  • 89 Department of Surgery, Inling Hospital, Nanjing University School of Medicine, Nanjing, China
  • 90 Division of Infectious Diseases, Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO USA
  • 91 Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • 92 Department of Surgery, Universidad Nacional de Asuncion, Asuncion, Paraguay
  • 93 Department for Traumatology and Orthopedic Surgery, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke (UW/H), Cologne, Germany
  • 94 Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
  • 95 Health Research Program, Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia
  • 96 Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia
  • 97 First Department of Surgery, Tzaneion General Hospital, Piraeus, Greece
  • 98 Service of General Surgery, Hospital Complex of Jaén, Jaén, Spain
  • 99 Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
  • 100 Servicio de Anestesia y Reanimación, Hospital Universitario La Paz Madrid, Madrid, Spain
  • 101 Department of Surgery, Radiology, University Hospital of the West Indies, Kingston, Jamaica
  • 102 Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
  • 103 Departments of Medicine, Clinical Epidemiology and Biostatistics, and Pathology and Molecular Medicine, McMaster University, Hamilton, ON Canada
  • 104 Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Romania
  • 105 Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
  • 106 Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA
  • 107 Department of Surgery, Onandjokwe Hospital, Ondangwa, Namibia
  • 108 Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI USA
  • 109 Department of Surgery, University of Michigan, Ann Arbor, MI USA
  • 110 Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
  • 111 Clinic for General Surgery, Clinical Centre, Nis, Serbia
  • 112 Center of Anti-Infective Research and Development, Hartford, CT USA
  • 113 Department of Surgery, King Abdullah University Hospital, Irbid, Jordan
  • 114 Department of Surgery and Critical Care, Universidad del Valle, Fundación Valle del Lili, Cali, Colombia
  • 115 Intensive Care Medicine Department, Centro Hospitalar São João, University of Porto, Porto, Portugal
  • 116 Department of Microbiology, Grande International Hospital, Dhapasi, Kathmandu, Nepal
  • 117 Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil
  • 118 Department of General and Emergency Surgery, University Hospital Kraków, Kraków, Poland
  • 119 Department of Surgery, University of Campinas, Campinas, Brazil
  • 120 Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
  • 121 Fourth Department of Internal Medicine and Infectious Diseases Unit, National and Kapodstrian University-Medical School, Attikon University General Hospital, Athens, Greece
  • 122 John Farman Intensive Care Unit, University Hospitals, NHS Foundation Trust, Cambridge, UK
  • 123 Infectious and Tropical Diseases Department, University Hospital of Nancy, and EA 4360 APEMAC, Lorraine University, Nancy, France
  • 124 Department of General and Emergency Surgery, Riga East University Hospital 'Gailezers', Riga, Latvia
  • 125 Department of Trauma, Hospital Santo Tomas, Panama, Panama
  • 126 National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
  • 127 Emergency Post-operative Department, Otavio de Freitas Hospital and Hosvaldo Cruz Hospital, Recife, Brazil
  • 128 Department of General Surgery, Jesenice General Hospital, Jesenice, Slovenia
  • 129 Trauma and Acute Care Service, St Michael's Hospital, University of Toronto, Toronto, Canada
  • 130 Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland Australia
  • 131 Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBiS and Departamento de Medicina, Universidad de Sevilla, Seville, Spain
  • 132 General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
  • 133 JPS Health Network, Texas, TX USA
  • 134 Hospital Center Tondela Viseu, Tondela, Portugal
  • 135 Department of Aeromedical Services for Emergency and Trauma Care, Ehime University Graduate School of Medicine, Ehime, Japan
  • 136 Department of Surgery, University of Virginia Health System, Charlottesville, VA USA
  • 137 Department of Surgery, University of Sao Paulo, Ribeirao Preto, Brazil
  • 138 Unit of Hospital Pharmacy, Macerata Hospital, Macerata, Italy
  • 139 Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • 140 Department of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
  • 141 Office of Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, VA USA
  • 142 Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand
  • 143 Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
  • 144 Department of Emergency Surgery and Critical Care, Centro Medico Imbanaco, Cali, Colombia
  • 145 Department of Surgery, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
  • 146 Department of Surgery, North Estonia Medical Center, Tallinn, Estonia
  • 147 Department of Molecular Biology, Tran Hung Dao Hospital, No 1, Tran Hung Dao Street, Hai Ba Trung Dist, Hanoi, Vietnam
  • 148 Department of Infectious Diseases, John Peter Smith Health Network, Fort Worth, Texas USA
  • 149 Institute of Infectious Diseases, Catholic University, Rome, Italy
  • 150 First Department of Surgery-Department of Abdominal, Thoracic Surgery and Traumatology, General University Hospital, Prague, Czech Republic
  • 151 Department of Surgery, Medical University of Graz, Graz, Austria
  • 152 Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
  • 153 Department of Surgery, Medical School University of Pécs, Pécs, Hungary
  • 154 Department of Urology, Pediatric Urology and Andrology, Medical Faculty of the Justus Liebig University Giessen, Giessen, Germany
  • 155 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affilliated Hospital, Zhejiang University, Zhejiang, China
  • 156 Trauma and Emergency Surgery Department, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
  • 157 Department of Antibiotics and Infection Control, Rudolfstiftung Hospital, Vienna, Austria
  • 158 Infection Control Unit, Angers University, CHU d'Angers, Angers, France
  • 159 Division of Trauma and Surgical Critical Care, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL USA
  • 160 Department of Surgery, University of Pittsburgh, Pittsburgh, PA USA
  • 161 VU University Medical Center, Amsterdam, The Netherlands
  • 162 Department of General Surgery, Maggiore Hospital, Parma, Italy
World J Emerg Surg, 2017;12:34.
PMID: 28775763 DOI: 10.1186/s13017-017-0145-2

Abstract

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 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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