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TECHNICAL REPORTSystematic review and evidence-based guidance on perioperative antibiotic prophylaxisModality 10In surgical departments, patterns of MDROs and incidence of Clostridium difficile infections should be monitoredproactively so PAP can be appropriately adjusted.Table 18. Studies supporting Modality 10 and quality of evidenceQuality of study in respect to internal andexternal validity (Ranji et al. [23])Itani et al. 2008, RCT N.A. 4Carignan et al. 2008,retrospective cohort studyN.A. 3Kato et al. 2007, non-CBA Moderate 2Quality of evidence according to theGRADE approach [24]** Quality of evidence according to the GRADE approach: 4=high quality, 3=moderate quality, 2=low quality, 1=very low qualityN.A. = not applicable3.2 Results of the expert meetings3.2.1 First expert meeting, Berlin, GermanyBefore the first meeting took place, the experts were asked to comment on the initial PAP modalities as derivedfrom the systematic review. The results of the experts’ replies to the initial 10 PAP modalities are shown in Figure 3.The systematic review was presented at the first expert meeting, and experts were asked to comment. Commentsand discussion were recorded. The 10 PAP modalities were ranked by the authors of this literature review anddiscussed with regard to EU-wide applicability and implementability.At the end of the first expert meeting, the experts agreed unanimously on the following 10 PAP modalities (Table19).Figure 3. Expert grading of the proposed PAP modalitiesStrongly agree Agree Neither agree nor disagree Disagree Strongly disagreeForming a multidisciplinary AM team and establishing a PAP protocolAudit and structured feedback for OR staff performed by AM teamPeriodical surveillance of data on multidrug-resistant bacteriaStop of PAP administration < 24 hours post surgeryAdministration of PAP by anaesthesiologistAdministration of single dose of PAP instead of multiple dosesRevision of PAP protocol/guidelines by the AM teamAdministration of PAP 30 to 60 minutes before incisionRegular education of OR staff about adequate PAPYearly audits and feedback for OR staffAdministration of PAP within 30 minutes before incisionImplementation of reminder system (i.e. computerbased, checklist or time-out)Implementation of computer-assisted automatic stop order for PAPAdjustment of PAP dosage according to patient's weightScreening of patients for multidrug-resistant bacteria pre-operatively.0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%27