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

Evaluation of the appropriate perioperative antibiotic prophylaxis in Italy

BACKGROUND

The appropriate use of antibiotics prophylaxis in the prevention and reduction in the incidence of surgical site infection is widespread. This study evaluates the appropriateness of the prescription of antibiotics prophylaxis prior to surgery amongst hospitalized patients in the geographic area of Avellino, Caserta, and Naples (Italy) and the factors associated with a poor adherence.

METHODS

A sample of 382 patients admitted to 23 surgical wards and undergoing surgery in five hospitals were randomly selected.

RESULTS

Perioperative antibiotic prophylaxis was appropriate in 18.1% of cases. The multivariate logistic regression analysis showed that patients with hypoalbuminemia, with a clinical infection, with a wound clean were more likely to receive an appropriate antibiotic prophylaxis. Compared with patients with an American Society of Anesthesiologists (ASA) score ≥4, those with a score of 2 were correlated with a 64% reduction in the odds of having an appropriate prophylaxis. The appropriateness of the timing of prophylactic antibiotic administration was observed in 53.4% of the procedures. Multivariate logistic regression model showed that such appropriateness was more frequent in older patients, in those admitted in general surgery wards, in those not having been underwent an endoscopic surgery, in those with a higher length of surgery, and in patients with ASA score 1 when a score ≥4 was chosen as the reference category. The most common antibiotics used inappropriately were ceftazidime, sultamicillin, levofloxacin, and teicoplanin.

CONCLUSIONS

Educational interventions are needed to improve perioperative appropriate antibiotic prophylaxis.

Factors associated with adherence to prophylactic antibiotic therapy for elective general surgeries in Japan

OBJECTIVE

To identify the factors associated with inappropriate antibiotic use during elective general surgeries.

DESIGN

Cross-sectional analysis of administrative dataset.

SETTING

Sixty two acute-care hospitals in Japan.

PARTICIPANTS

Two thousand and three hundred and seventy-three patients who had undergone inguinal hernia repair, appendectomy or laparoscopic cholecystectomy in 2004 and 2005.

MAIN OUTCOME MEASURES

The appropriateness of antibiotic prophylaxis was evaluated in terms of the drug-selection and treatment-duration guidelines used in Japan, and the factors associated with guideline adherence were examined by multivariate logistic regression analysis.

RESULTS

The adherence rates for drug selection and treatment duration were 53-84 and 38-68% depending on surgical procedures, respectively. Patient age, sex and risk factors for surgical-site infections were not associated with inappropriate use of antibiotics after adjustment of other factors. The large size of the hospitals was significantly associated with inappropriate antibiotic usage. In hospitals with high surgical volume, the treatment duration was appropriate while antibiotic selection was relatively consistent but not adherent to the guidelines, implicating the presence of local practice routines.

CONCLUSIONS

Our results suggest that education and other methods should be used to encourage adherence to clinical guidelines on surgical antibiotic use, especially on duration of treatment. Increasing surgical volume may facilitate the standardization of clinical practice and improve the quality of health care.