Strengthening surgical antibiotic stewardship in low-resource settings: a multicentre, prospective, quality improvement study - Scorecard - MDSpire

Strengthening surgical antibiotic stewardship in low-resource settings: a multicentre, prospective, quality improvement study

  • By

  • Clean Cut Investigators Group

  • John Ibyishaka

  • Yvonne Uwabagira

  • Mediatrice Cyuzuzo

  • Celine Tuyishime

  • Florentine Uwingabire

  • Pierre Celestin Ukobizaba

  • Jean Paul Niyigena

  • Jean Yves Shyrirakera

  • Marie Chantal Umurerwa

  • Gaudence Kabagwira

  • Vestine Musabende

  • Abraham Kwizera

  • Innocent Byamungu

  • Deborah Mukantibaziyaremye

  • Leontine Neema

  • Pierrine Nyirangeri

  • Valens Majyambere

  • Emmanuel Nsengimana

  • Andrew Oryono

  • Fabrice Habarugira

  • Valens Dusabimana

  • Diane Senga

  • Gerard Harerimana

  • Aloys Hakizimana

  • Yves Berard Niyomugabo

  • Senait Bitew Alemu

  • Sara Taye Hale

  • Barnabas Alayende

  • Maia R Nofal

  • Alype Rwamatwara

  • Roda Uwayesu

  • David Tuyisenge

  • Justin Bayisenga

  • Ronald Tubasiime

  • Febronie Muhorakeye

  • Assefa Tesfaye

  • Samantha Steeman

  • Hillena Kebede

  • Natnael Gebeyehu

  • Abebe Bekele

  • Tihitena Negussie Mammo

  • Thomas G Weiser

  • December 10, 2025

  • 0 min

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Clinical Scorecard: Enhancing Antibiotic Stewardship in Surgical Practices within Resource-Limited Environments: A Multicenter, Prospective Quality Improvement Investigation

At a Glance

CategoryDetail
ConditionSurgical site infections (SSIs) and antimicrobial resistance (AMR)
Key MechanismsOverprescribing of prolonged postoperative antibiotic prophylaxis linked to poor infection prevention and control (IPC) practices; integration of antimicrobial stewardship with IPC quality improvement
Target PopulationSurgical patients in low-resource hospital settings in Rwanda
Care SettingResource-limited hospitals implementing surgical care and infection prevention programs

Key Highlights

  • Prolonged postoperative antibiotic prophylaxis (>24 hours) is common in low-resource settings but does not reduce SSI rates.
  • An integrated quality improvement program combining antimicrobial stewardship and IPC improvements significantly reduced prolonged antibiotic use and improved IPC compliance.
  • Early cessation of antibiotics did not increase SSI rates, supporting WHO recommendations against prolonged prophylaxis even where IPC practices are poor.

Guideline-Based Recommendations

Diagnosis

  • Assess surgical patients for SSI risk using wound class, procedure type, and urgency.
  • Monitor compliance with IPC standards including WHO Surgical Safety Checklist, antisepsis, instrument reprocessing, sterile field maintenance, gauze counting, and preoperative antibiotic timing.

Management

  • Avoid prolonged postoperative antibiotic prophylaxis beyond 24 hours.
  • Implement targeted training and local antimicrobial stewardship guidelines.
  • Use an ‘antibiotic timeout’ checklist during ward rounds to reassess ongoing antibiotic need.
  • Strengthen IPC practices through validated programs like Clean Cut.

Monitoring & Follow-up

  • Track compliance with IPC standards regularly.
  • Monitor rates of prolonged antibiotic prophylaxis and SSI incidence over 30 days postoperatively.
  • Use risk-adjusted analyses to evaluate impact on SSI rates.

Risks

  • Prolonged antibiotic prophylaxis contributes to antimicrobial resistance without reducing SSI risk.
  • Poor IPC practices increase SSI risk and drive inappropriate antibiotic use.

Patient & Prescribing Data

1464 surgical patients (334 pre-intervention, 1130 post-intervention) in four Rwandan hospitals

Prolonged prophylaxis decreased from 40.7% pre-intervention to 14.1% post-intervention; IPC compliance improved from 2.6 to 5.0 of 6 standards; no significant increase in SSI rates with early antibiotic cessation.

Clinical Best Practices

  • Integrate antimicrobial stewardship with IPC quality improvement initiatives.
  • Engage multidisciplinary stakeholders for guideline development and dissemination.
  • Use structured antibiotic timeouts to promote guideline adherence.
  • Focus on strengthening IPC measures rather than relying on prolonged antibiotic prophylaxis.
  • Regularly audit and provide feedback on IPC compliance and antibiotic use.

References

Original Source(s)

Strengthening surgical antibiotic stewardship in low-resource settings: a multicentre, prospective, quality improvement study

  • by Clean Cut Investigators Group, John Ibyishaka, Yvonne Uwabagira, Mediatrice Cyuzuzo, Celine Tuyishime, Florentine Uwingabire, Pierre Celestin Ukobizaba, Jean Paul Niyigena, Jean Yves Shyrirakera, Marie Chantal Umurerwa, Gaudence Kabagwira, Vestine Musabende, Abraham Kwizera, Innocent Byamungu, Deborah Mukantibaziyaremye, Leontine Neema, Pierrine Nyirangeri, Valens Majyambere, Emmanuel Nsengimana, Andrew Oryono, Fabrice Habarugira, Valens Dusabimana, Diane Senga, Gerard Harerimana, Aloys Hakizimana, Yves Berard Niyomugabo, Senait Bitew Alemu, Sara Taye Hale, Barnabas Alayende, Maia R Nofal, Alype Rwamatwara, Roda Uwayesu, David Tuyisenge, Justin Bayisenga, Ronald Tubasiime, Febronie Muhorakeye, Assefa Tesfaye, Samantha Steeman, Hillena Kebede, Natnael Gebeyehu, Abebe Bekele, Tihitena Negussie Mammo, Thomas G Weiser

  • December 10, 2025

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