Antimicrobial Stewardship in oral and maxillofacial surgery: melting the iceberg.

Objective: Irrational antibiotic consumption contributes to antimicrobial resistance, adverse effects, and rising costs. Antimicrobial Stewardship (AMS) supports rational antibiotic use through restrictive and supportive measures. In oral and maxillofacial surgery (OMFS), antibiotic consumption is consistently high, and evidence-based guidelines are often lacking. We evaluated a multimodal AMS intervention on antibiotic use in an OMFS department. Design: Before-after study. Setting: OMFS department of a German university hospital. Patients: Hospitalized patients treated in the OMFS department. Intervention: For 12 months, the AMS team conducted weekly ward visits, providing recommendations regarding antibiotic therapy and surgical antibiotic prophylaxis (SAP). In parallel, a mandatory consensus guideline covering these aspects was developed and implemented. Antibiotic use, prevalence, duration of therapy, and SAP before, during, and after the intervention were evaluated; clinical outcomes were not assessed. Results: Pre-intervention, over 70% of patients received antibiotics. Median duration of antibiotic therapy and SAP was 12 and 9 days, respectively. Antibiotic consumption reached 63.8 defined daily dosages per 100 patient days, exceeding national values (median 40.1). During the intervention, antibiotic prevalence decreased below 50% and the duration of antibiotic therapy and SAP was shortened to 9 and 3 days, respectively. Antibiotic consumption decreased by 26% whereas national values increased by nearly 50%. After weekly consultations ceased, antibiotic use rose again but remained below national levels. Conclusions: Antibiotic consumption is high in OMFS. Regular AMS support including consensus guidelines can reduce antibiotic use substantially and sustainably. However, clinical outcomes need to be correlated and adequately staffed AMS teams are needed.