Rising awareness on appropriate use of antibiotics in surgery

Antimicrobial resistance (AMR) is one of the greatest threats to public health, sustainable development and security worldwide. Its prevalence has increased alarmingly over the past decades.

Although most physicians are aware of the problem of AMR, most underestimate this problem in their own hospital and prescribe inappropriately antibiotics.

Antimicrobial stewardship program (ASP) is an emerging strategy designed to optimize outcomes and reduce the emergence of resistant organisms. Educating clinicians in the appropriate use of antibiotics is an essential part of antimicrobial stewardship.

The best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy and routine clinical practice.

In line with a One Health approach, raising awareness of AMR by education and dissemination of information to stakeholders is an important factor in changing behaviors.

Appropriate use of antibiotics should be integral to good clinical practice and standards of care and Physicians should be aware of their role and responsibility for maintaining the effectiveness of current and future antibiotics.

Since physicians are primarily responsible for the decision to use antibiotics, educating them and changing the attitudes and knowledge that underlie their prescribing behaviour are crucial for improving antimicrobial prescription. The ultimate goal of an ASP should be to stimulate a behavioural change in prescribing practice. Educational interventions should include any attempt to persuade physicians to modify their clinical practice.

Education is fundamental to every ASP. A range of factors such as diagnostic uncertainty, fear of clinical failure, time pressure or organisational contexts can complicate prescribing decisions. However, due to cognitive dissonance (recognising that an action is necessary but not implementing it), changing prescribing behaviour is extremely challenging.

We propose that the best means of improving antimicrobial stewardship should involve collaboration among various specialties within a healthcare institution including prescribing physicians.

Successful ASPs should focus on collaboration between all healthcare professionals to shared knowledge and widespread diffusion of practice. Involvement of prescribing physicians in ASPs may rise their awareness on antimicrobial resistance.

Massimo Sartelli