SIS Endorses and Participates In the CDC’s “Get Smart About Antibiotics” Initiative
Medicine may be losing the battle to treat serious infections-new antibiotics are few and far between, and bacteria are becoming increasingly resistant to the antibiotics that are still usable. That’s why it is incumbent upon every practitioner, regardless of specialty, to use carefully the antimicrobial agents we do have. This antibiotic stewardship is crucially important so that infections are treated (and prevented) timely and effectively with antibiotics, but also so that misuse and overuse become a thing of the past.
A core mission of SIS is to work both to prevent and treat infections of surgical patients. Rational and parsimonious antibiotic use is an important part of infection management, one that SIS has been espousing for at least the last 16 years, since SIS Past-President, SIS Foundation Executive Director, and Founding Editor of Surgical Infections Philip S. Barie published Modern Surgical Antibiotic Prophylaxis and Therapy-Less is More in the inaugural issue of the journal. [1].
Recently, SIS Past-President Robert G. Sawyer led a group that published the SIS-endorsed STOP-IT trial, which demonstrated that four days of antimicrobial therapy was equivalent to an eight-day course for treatment of complicated intra-abdominal infection when surgical source control was adequate [2]. Post-hoc analyses have suggested that neither obese patients [3], patients presenting with sepsis [4], those with polymicrobial infections [5] or risk factors for complications [6], nor those undergoing initial percutaneous drainage [7] require a longer duration of therapy. Nor does addition of vancomycin to the regimen provide any additive benefit [8]. A video interview with Doctor Sawyer can be found here.
The principles of stewardship apply equally to the prescribing of surgical antibiotic prophylaxis [1]. Published in 2013 by SIS in collaboration with the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society for Healthcare Epidemiology of America, revised guidelines are available for the effective and safe use of prophylactic antibiotics [9]. SIS considers this document a “must-read, must-heed” for all surgeons [10].
In conjunction with this important CDC initiative, SIS is pleased to announce the e-publication in Surgical Infections, in conjunction with the World Society for Emergency Surgery, of a position statement on antimicrobial stewardship in surgery [11]. Adhering to the principles of antibiotic stewardship in surgical practice is crucial for the optimal care of the surgical patient.
If you are reading this as a patient or a loved one, click here for a link to answers to frequently asked questions about antibiotic stewardship. If you are a surgical trainee or part of a surgical team, link here to the SIS YouTube channel, where you will find a series of short video presentations about maintaining the operating room environment. After all, antibiotics alone are not enough to prevent infection following surgery.
Bibliography
- Barie PS. Modern surgical antibiotic prophylaxis and therapy--less is more. Surg Infect (Larchmt). 2000;1:23-29.
- Sawyer RG, Claridge JA, Nathens AB, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med 2015;372:1996-2005.
- Dietch ZC, Duane TM, Cook CH, et al. Obesity is not associated with antimicrobial treatment failure for intra-abdominal infection. Surg Infect (Larchmt).2016;17:412-421.
- Rattan R, Allen CJ, Sawyer RG, et al. Patients with complicated intra-abdominal infection presenting with sepsis do not require longer duration of antimicrobial therapy. J Am Coll Surg 2016; 222:440-446.
- Shah PM, Edwards BL, Dietch ZC, et al. Do Polymicrobial intra-abdominal infections have worse outcomes than monomicrobial intra-abdominal infections? Surg Infect (Larchmt) 2016;17:27-31.
- Rattan R, Allen CJ, Sawyer RG, Patients with risk factors for complications do not require longer antimicrobial therapy for complicated intra-abdominal infection. Am Surg 2016;82:860-866.
- Rattan R, Allen CJ, Sawyer RG, et al. Percutaneously drained intra-abdominal infections do not require longer duration of antimicrobial therapy. J Trauma Acute Care Surg. 2016;81:108-113.
- Sanders JM, Tessier JM, Sawyer RG, et al. Inclusion of vancomycin as part of broad-spectrum coverage does not improve outcomes in patients with intra-abdominal infections: A post hoc analysis. Surg Infect (Larchmt) 2016 Aug 2. [Epub ahead of print].
- Bratzler DW, Dellinger EP, Olsen KM. et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt).2013;14:73-156.
- Barie PS. Guidelines for antimicrobial prophylaxis in surgery: a must-read, must-heed for every surgeon. 2013;14:5-7.
- Sartelli M, Duane TM, Catena F, et al.. Antimicrobial stewardship: A call to action for surgeons. Surg Infect (Larchmt) 2016 Nov 9 [Epub ahead of print].
What is Antibiotic Stewardship?
Dr. Arthur Celestin, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Dr. Nathan Elwood, University of Virginia
Dr. Drew Farmer, Baylor University Medical Center at Dallas
Dr. Taryn Hassinger, University of Virginia Health System