CLINICAL AUDIT: ADHERENCE TO EMPIRIC ANTIBIOTIC LOCAL PROTOCOL IN PERITONITIS IN A SURGICAL ICU. ARE WE IMPROVING?
Authors: Navarro-Echevarría P, Fernández-Téllez L, Rodríguez-Esteve A, Bernardino-Santos M, Olivera-Moreno D, García del Valle y Manzano S. University Hospital Fundación Alcorcón (Madrid-Spain). Department of Anaesthesiology and Intensive Care
Objectives: Adequate and early empiric antibiotic treatment and surgical source control improves the prognosis of patients with peritonitis. The aim of this second audit is to review the fulfilment of the Local Intraabdominal Infection protocol approved in 2013 by the Infection and Antibiotic Policy Commission and to compare the results with a previous audit (2015)1. Materials and Methods: We selected patients with peritonitis admitted at our surgical ICU (January 2015 to December 2016). Following data were collected: age, sex, isolated microorganism in cultures and antibiogram, temperature, hypotension, vasoactive treatment, tachycardia, tachypnea, leukocytosis or leukopenia, mechanical ventilation, renal substitutive treatment, lactate >2mmol/L, high risk factors for worse clinical outcomes, empiric antibiotic treatment and who initiated it. We compared the empiric treatment administered with the local protocol recommendation and the present adherence to protocol with the previous audit. Results: 43 patients with peritonitis admitted for more than 24 hours were included. The empiric antibiotic treatment was initiated by Anaesthesia in 29 patients (67.4%), 5 by General Surgery (11.6%), 8 by the Emergency Unit (18.6%) and in one case by Internal Medicine (2.3%), while in the previous audit the empiric antibiotic was started by Anaesthesia in most cases (83.3%). The antibiotic protocol was followed in 20 patients (46.5%), comparing to the previous study that was followed in 52% (p<0,01). Much more samples for microbial culture were obtained during surgery from 34 patients (79%), compared to the previous 39.5% (p>0,01).
Conclusions: We achieved to double the percentage of intraoperative samples. This allows the later correct adjustment of the antibiotic treatment. Emergency and Surgery Units are much more involved and the first dose of antibiotic is given earlier. Actions to improve the fulfilment of the intraabdominal infection protocol must be taken in order to improve the adherence to local guideline. Finally, our protocol should be reviewed to adjust it to the new SOFA criteria2. References:
1. Adherence to empiric antibiotic treatment in peritnotis in a surgical ICU. Olivera D. The European Anaesthesiology Congress.Berlin 2015
2. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 Intensive Care Med 2017

07 / Clinical audit: Adherence to empiric antibiotic local protocol in peritonitis in a surgical ICU. Are we improving?