Antibiotics | Using Behavioral Intervention Strategies to Reduce Perioperative Antibiotic Use in Cardiac Device Surgery

This study effectively reduced unnecessary postoperative oral antibiotic use following cardiac device surgery through multidimensional behavioral intervention strategies while maintaining sustained low surgical site infection rates. The research emphasizes the critical role of behavioral change in antimicrobial stewardship programs.

 

Literature Overview
The article 'Antimicrobial Stewardship in Cardiac Device Surgery: Impact of Behavioural Change Interventions on Extended Prophylaxis Practices' published in Antibiotics journal reviews and summarizes research implementing behavioral interventions to optimize perioperative antibiotic use in cardiac device surgery. The study demonstrates that while clinical guidelines recommend single-dose preoperative antibiotic prophylaxis, extended use remains prevalent in clinical practice. Through behavioral change strategies, the research team successfully reduced extended antibiotic usage and validated its safety and efficacy.

Background Knowledge
Cardiac device surgery (e.g., pacemaker implantation or replacement) represents common cardiac procedures where preoperative antibiotic prophylaxis is standard practice. However, many clinicians persistently extend antibiotic duration without evidence-based justification. Building on behavioral science and multidisciplinary collaboration, this study introduces behavioral change techniques including goal setting, feedback mechanisms, and clinical pathway optimization to reduce unnecessary antibiotic use. The research highlights the importance of behavioral interventions in antimicrobial stewardship, particularly given increasing antibiotic resistance. Reducing unnecessary use is crucial for patient safety and healthcare resource management.

 

 

Research Methods and Experiments
This study employed a single-center retrospective cohort design at Singapore General Hospital. Participants included uncomplicated patients aged ≥21 years undergoing pacemaker implantation or replacement between October 2022 and March 2025. Data were collected from hospital electronic health records to analyze antibiotic usage patterns, surgical site infection rates, and clinical characteristics. The antimicrobial stewardship (ASP) program implemented multidimensional behavioral interventions including data-driven feedback, targeted education, engagement of ASP Champions (opinion leaders), and clinical pathway revisions.

Key Conclusions and Perspectives

• Extended antibiotic use decreased significantly from 43.8% to 24.0% after ASP implementation (p < 0.01).
• Both standard and extended prophylaxis groups maintained identical surgical site infection rates at 0.8% (p = 1.000), with all infections being superficial, demonstrating the safety of reduced duration.
• Prescription behavior change was effectively achieved through identification and empowerment of ASP Champions leveraging peer influence.
• Postoperative oral antibiotic prescriptions decreased following clinical pathway optimization, demonstrating electronic pathway modifications as effective prescription management tools.
• Overall antibiotic use decreased from 20.7% to 16.3% (p < 0.01), indicating ASP strategies generate spillover effects in broader antimicrobial management.

Research Significance and Prospects
The study demonstrates that behavioral science-based antimicrobial stewardship strategies effectively reduce unnecessary postoperative antibiotic extension while maintaining surgical site infection stability. Future research should assess the generalizability of these interventions across different healthcare institutions and broader surgical categories, while exploring mechanisms for sustaining long-term effects. Additionally, investigating behavioral intervention impacts on other perioperative antimicrobial use patterns merits further exploration.

 

 

Conclusion
This study successfully reduced unnecessary extended postoperative antibiotic use through behavioral science strategies while ensuring patient safety. Multidimensional ASP approaches including data feedback, education, opinion leader engagement, and clinical pathway optimization effectively drove antimicrobial stewardship practice changes. The research emphasizes that traditional stewardship programs have primarily focused on intravenous broad-spectrum antibiotics, yet oral antibiotic management remains equally important. Continued implementation of behavioral interventions should be prioritized to address antimicrobial use patterns across diverse clinical scenarios and enhance global antimicrobial stewardship effectiveness.

 

Li Wen Loo, Yvonne Peijun Zhou, Yi Bo Wang, Lai Wei Lee, and Jasmine Shimin Chung. Antimicrobial Stewardship in Cardiac Device Surgery: Impact of Behavioural Change Interventions on Extended Prophylaxis Practices. Antibiotics.