Improving Antimicrobial Utilization and Infection Control in Ophthalmology: An Information-Assisted Transparent Supervision and Multidisciplinary Team Model.

Background: Using antimicrobials wisely is crucial for effective treatment and reducing antimicrobial resistance (AMR). As ocular infections can lead to serious consequences and ophthalmic surgery has a great impact on patients, the application of antimicrobials in ophthalmology needs to be managed in a standardized manner.

Methods: A multidisciplinary team (MDT) on antimicrobial stewardship was set up by adopting comprehensive management measures and a continuous improvement model with all-staff training and empowerment, information-assisted medical prescription control, and transparent supervision.

Results: After intervention, the antibiotics use density, antibiotics utilization rate and antibiotics prophylactic utilization rate for type I incision operation among inpatients decreased from 30.02%, 49.64% and 58.04% in 2018 to 8.78% (decrease by 70.77%), 18.31% (p < 0.001) and 8.93% (p < 0.001) in 2022, respectively; the microbiological submission rate related to antibiotics utilization, etiological submission rate before antibiotic therapy and before combined use of key antibiotics rose from 13.44%, 17.39% and 50.00% to 27.33% (p < 0.001), 51.3% (p < 0.001) and 100.00% (increase by 100%), respectively; the incidence of nosocomial infection and surgical site infection for type I incision operation both reduced to zero, while the use of hand hygiene products markedly increased. For pathogen detection, a total of 489 pathogens were isolated from 2018 to 2022, of which 69.30% were Gram-positive bacteria, 26.02% were Gram-negative bacteria, and 4.68% were fungi. Ocular secretion was the main detection site (89.31%). Antibiotic resistance analysis results indicated that Staphylococci maintained complete sensitivity to linezolid, vancomycin, and teicoplanin. Streptococcus pneumoniae maintained complete sensitivity to vancomycin, benzathine, levofloxacin, and moxifloxacin, with resistance to penicillin G and ceftriaxone down to zero.

Conclusion: Multidisciplinary team and information-assisted transparent supervision have displayed obvious effects in promoting the standardized application of antimicrobials in ophthalmology, via distinctly improving indicators relevant to antimicrobial application and nosocomial infection. Our work may provide guidance for improving the medical quality and curbing the AMR.