Audit of antibiotic prophylaxis in surgery

Czech version

Authors: P. Domecký ¹; L. Hauschke ²; V. Černý ³; J. Malý ¹
Authors‘ workplace: Katedra sociální a klinické farmacie, Farmaceutická fakulta v Hradci Králové, Univerzita Karlova ¹; Oddělení klinické farmacie, Krajská zdravotní, a. s., Ústí nad Labem ²; Klinika anesteziologie, perioperační a intenzivní medicíny Univerzita J. E. Purkyně v Ústí nad Labem, Masarykova nemocnice v Ústí nad Labem ³
Published in: Anest. intenziv. Med., 31, 2020, č. 4, s. 152-156
Category: Original Article

Overview

Objective: Evaluation of antibiotic prophylaxis in surgery.

Design: Cross-sectional study.

Setting: Regional healthcare facility.

Material and methods: This study assessed patients (≥18 years old) who underwent a surgical operation in the defined period and agreed to participate in the study. Data were collected through the form for antibiotic prophylaxis perioperative record (identification and gender, information about surgical operation, choice of antibiotic, dose of antibiotic, time of administration and duration of it), and from the medical records. Collected data were compared with evidence-based medicine and internal hospital standards. The descriptive statistics were used for evaluation.

Results: 197 patients (103 men and 94 women) with average age of 56.5 years attended the study. Urological procedure was most frequently observed in 43 (21.8%) patients. 125 (63.5%) patients received antibiotic prophylaxis. The indication of the antibiotic prophylaxis was correct in 86.9% with the internal hospital standards and in 88.9% with the evidence-based medicine. Cefazolin was administered in the 52% of surgical procedures. Based on the detailed evaluation, some areas for revision have been identified in the internal hospital standards. It is necessary to define the general principles for antibiotic prophylaxis, to consider individual patient characteristics and more detailed specification of the individual surgical operations.

Conclusion: Some contradictions with the evidence-based medicine have been identified in the internal hospital standard for antibiotic prophylaxis. Certain differences from the internal hospital standards as well as evidence-based medicine have been found in the evaluation of antibiotic prophylaxis in practice.

Keywords:

Antibiotic prophylaxis – surgical site infection – adherence – guidelines

Sources

1. Bassetti M, Righi E, Astilean A, Corcione S, Petrolo A, Farina EC, et al. Antimicrobial prophylaxis in minor and major surgery. Minerva Anestesiol. 2015 Jan; 81(1): 76–91. Epub 2014 Feb 24. Review. PubMed PMID: 24561611.

2. Jindrák V, Hedlová D, Urbášková P. Antibiotická politika a prevence infekcí v nemocnici. Prague (CZ): Mladá fronta, 2014.

3. Bratzler DW, Hunt DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis. 2006 Aug 1; 43(3): 322–330. Epub 2006 Jun 16. PubMed PMID: 16804848.

4. Adámková V. Antibiotika v chirurgických oborech. Prague (CZ): Mladá fronta, 2016. Edice postgraduální medicíny.

5. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1; 70(3): 195–283. doi: 10.2146/ajhp120568. PubMed PMID: 23327981.

6. Namias N, Harvill S, Ball S, McKenney MG, Salomone JP, Civetta JM. Cost and morbidity associated with antibiotic prophylaxis in the ICU. J Am Coll Surg. 1999 Mar; 188(3): 225– 230. PubMed PMID: 10065809.

7. National Institute for Health and Clinical Excellence: Guidance. Surgical Site Infection: Prevention and Treatment. [on-line]. Dostupné z: https://www.nice.org.uk/guidance/ ng125/resources/surgical-site-infections-prevention-and-treatment-pdf-66141660564421

8. Gouvêa M, Novaes Cde O, Pereira DM, Iglesias AC. Adherence to guidelines for surgical antibiotic prophylaxis: a review. Braz J Infect Dis. 2015 Sep-Oct; 19(5): 517–524. doi: 10.1016/j. bjid.2015.06.004. Epub 2015 Aug 5. Review. PubMed PMID: 26254691.

9. Antibiotic prophylaxis in surgery. A national clinical guideline. SIGN [on-line]. [cit. 2019- 05-13]. Dostupné z: http://www.sign.ac.uk/assets/sign104.pdf

10. Surgical Antibiotic Prophylaxis Guideline: Adults. [on-line] [cit. 2019-05-13]. Dostupné z: https://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/WATAG/ Surgical-Antibiotic-Prophylaxis-Guideline.pdf.

11. Surgical Antibiotic Prophylaxis Guidelines. In: Nottingham University Hospitals [on-line]. [cit. 2019-05-13]. Dostupné z: https://www.nuh.nhs.uk/clinical-guidelines? smba 2z= - S&pag_page=4.

12. Beneš J, Gregor P, Mokráček A. Infekční endokarditida. In: Společnost infekčního lékařství ČLS JEP [on-line]. [cit. 2019-02-01]. Dostupné z: https://www.infekce.cz/ Standardy/IEDP.pdf.

13. Bratzler DW, Houck PM, Richards C, Steele L, Dellinger EP, Fry DE, et al. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg. 2005 Feb; 140(2): 174–182. PubMed PMID: 15724000.

14. van Kasteren ME, Kullberg BJ, de Boer AS, Mintjes-de Groot J, Gyssens IC. Adherence to local hospital guidelines for surgical antimicrobial prophylaxis: a multicentre audit in Dutch hospitals. J Antimicrob Chemother. 2003 Jun; 51(6): 1389–1396. Epub 2003 May 13. PubMed PMID: 12746377.

15. Fonseca LG, de Oliveira Conterno L. Audit of antibiotic use in a Brazilian University Hospital. Braz J Infect Dis. 2004 Aug; 8(4): 272–280. Epub 2004 Nov 19. PubMed PMID: 15565257.