Impact of antimicrobial stewardship interventions on appropriateness of surgical antibiotic prophylaxis. How to improve

Background and Objectives: Surgical Site Infections (SSIs) are the most common healthcare-associated infections and represent a major clinical problem in terms of mortality, morbidity, length of stay and overall costs. The appropriateness of Surgical Antibiotic Prophylaxis (SAP) is a key component to reduce the SSIs while the inappropriateness is a major cause of some emerging infections and selection of antibiotic resistance, therefore increasing healthcare costs. For this reasons international and national guidelines have been developed to guide clinicians in the optimal use of SAP. The The overall compliance to these guidelines is poor, with a high heterogeneity and as a consequence there is no universally recognized intervention to improve the appropriateness of SAP. The antimicrobial stewardship program is a systematic approach to improve appropriateness of antimicrobial use, to optimize the treatment of infections and to minimize the adverse effects associated with antibiotic use, like antimicrobial resistance, toxicity and costs. We describe a successfully Antimicrobial Stewardship (AMS) intervention on SAP appropriateness. Material and Methods: The prospective study was conducted at “Santa Maria” tertiary hospital in Terni, Umbria, in 12 main surgical units and was organized in three subsequent phases . The hospital defined evidence-based guidelines for optimal use of SAP, approved a new workflow to optimize the process of ordering, dispensing, administering and documenting SAP and created a satellite pharmacy in the operative block . Phase 1: we analysed 2059 elective surgical cases from January to June 2018 for 3 SAP parameters of appropriateness: indication, choice, dose. Phase 2: in July 2018 an audit was performed to analyse the result ; we reviewed 1781 elective surgical procedures from July to December 2018 looking for the same 3 SAP parameters of appropriateness. Results: The comparative analysis between phase 1 and 2 has demonstrated that the correct indication has a significant improvement (p-value 0.00128), moving from 73.63% in phase 1 to 77.82% in phase 2. The choice of antibiotic has not shown any significant improvement (p-value 0.4863) . The correct dose significantly improved (p-value< 2.2 1016 ), rising from 71.75% in phase 1 to 86.19% in phase 2. The overall compliance had a significant improvement (p-value <5.6 1012) passing from 40.21% in tphase 1 to 51.15% in phase 2. Conclusions: Our prospective study demonstrated a model of succesfully antimicrobial stewardship intervention that improves appropriateness of SAP

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data