Antibiotic prophylaxis for surgical procedures: a survey from an Italian university hospital

Antibiotic Prophylaxis in Surgery: An Observational Prospective Study Conducted in a Large Teaching Hospital in Naples

This was a 9-month observational prospective study conducted in two steps to evaluate surgical prophylaxis procedures used by surgeons in several departments of the Second University of Naples (SUN). In step 1 (4 months), we collected and analyzed data on surgical interventions and antibiotic prophylaxis. Surgeons were informed of the analysis outcome and were given an antibiotic prophylaxis protocol based on international guidelines. In step 2 (5 months), we collected data on surgical interventions and antibiotic prophylaxis, and compared them with step 1 data. The analysis of 354 forms (step 1) showed that third-generation cephalosporins were the preferred prophylactic antibiotics. The analysis of 369 forms (step 2) showed that ceftriaxone and ampicillin were the most frequently used antibiotics. Surgeons did not comply with guidelines for antibiotic prophylaxis as regards type of antibiotic and treatment duration but implementation of antibiotic prophylaxis protocols resulted in more appropriate and better timing of antibiotic prophylaxis.

Practice guideline adherence and health care outcomes--use of prophylactic antibiotics during surgery in Taiwan

RATIONALE, AIMS AND OBJECTIVES

To evaluate adherence to guidelines for prophylactic antibiotic use in total knee replacement (TKR) and total hip replacement (THR) procedures and to examine the associations between guideline adherence and health care outcomes.

METHODS

Using nationwide health insurance claims data, all adult inpatients undergoing TKR or THR procedures at teaching hospitals from 2002 to 2006, were included. Guideline adherence rates were assessed every year according to the national guidelines introduced in 2004. Multiple regression analyses with generalized estimating equations models were used to examine the relationships between the deliberate variables.

RESULTS

The guideline adherence rates stably increased from 14.07% in 2002 to 28.34% in 2006. The 2006 dataset included 12 863 observations. The results revealed that guideline adherence was negatively associated with length of stay and health care expenses with beta = -0.0207 and -0.0087, respectively (P < 0.0001). The 30-day readmission rate was 1.54% among the patients seen in 2006, and it was significantly different between the two groups, with 0.90% of the adherence group and 1.82% of the non-adherence group being readmitted (P = 0.0002).

CONCLUSIONS

The guideline adherence for prophylactic use of antibiotics is improving in Taiwan and is associated with a shorter length of stay, fewer medical expenses and lower 30-day readmission rates. Promoting evidence-based practice guidelines may be beneficial to patients and health care providers.

Surgical antibiotic prophylaxis in a Turkish university hospital

A prospective study was performed to assess the practice of antibiotic prophylaxis for surgical procedures in Pamukkale University Hospital, Denizli, Turkey. All surgical procedures performed between April 1 and July 31, 2001, were included. During the study period 897 operations were reviewed. 96% of all procedures were elective, 4% emergencies. Approximately 70.7% were clean surgery, 25.3% clean-contaminated, 2.8% contaminated, and 1.2% dirty. 98% of patients (879) received antibiotic prophylaxis. Although timing of prophylaxis was appropriate in all procedures, the duration of prophylaxis was optimal in only 47.7% of all cases. Sulbactam/ampicillin (SAM), cefazolin and cefepime were the most commonly used antibiotics during the study period. The results of our study suggest that the choice of prophylactic antimicrobial agent was inappropriate in most cases. In conclusion, we think that compliance regarding the optimal choice, frequency, and duration of perioperative antibiotic prophylaxis is not adequate in our hospital, and that more education on the subject is necessary.

Antibiotic use in an Italian university hospital

The aim of this retrospective observational study was to investigate: a) expenditure for antibiotics with respect to the total pharmacy drug budget and to costs of other medical devices; b) the most frequently used antimicrobial classes and molecules; c) the clinical units that most frequently use antimicrobial therapy; d) the preferred route of administration; e) consumption patterns of antibiotics over two periods (January-September 1999 and January-September 2000). The consumption of a single antimicrobial agent was expressed as daily defined doses (DDD) per 100 bed days. In 1999 drugs accounted for 56% of the total costs but decreased to 46% in 2000. Antibiotics accounted for 15% of the pharmacy's overall acquisition costs in 1999 and dropped to 13% in 2000. In both 1999 and 2000, penicillins were used most, followed by cephalosporins and aminoglycosides. In 1999, the most frequently used antibiotic was amoxicillin (4.02 DDD per 100 bed days) followed by ceftazidime, ampicillin, ceftriaxone, and co-amoxiclav. In 2000 ceftriaxone was the most commonly used antibiotic (4.35 DDD per 100 bed days) followed by co-amoxiclav, amoxicillin, ceftazidime. The general surgery, medical therapy and infectious diseases units accounted for the majority of penicillin consumption, while cephalosporins were most widely used in general surgery, orthopedics and neurosurgery units. Parenteral administration was the most widely used route in both years.

Surgical prophylaxis: the evolution of guidelines in an era of cost containment

Postoperative infections account for a large proportion of hospital-acquired infections, are associated with a high morbidity and mortality, and place a large burden upon the inpatient healthcare budget. Prophylaxis is desirable and is based on a combination of preoperative preparation, surgical techniques, perioperative antibiotic prophylaxis and postoperative wound care. There is considerable evidence that antibiotics are used excessively and inappropriately in the prevention and treatment of hospital-acquired infections, including surgical-site infections. In the case of the latter, timing of prophylaxis is crucial to success yet antibiotics are often administered at the wrong time or for too long a period, with implications for the cost of patient care. Several studies have shown that the local implementation of practice guidelines can yield significant improvements in antibiotic use and the cost of surgical prophylaxis. More rational use of antibiotics is likely to benefit the treatment of future surgical patients by reducing the pressure to select for antibiotic-resistant bacterial pathogens.