Antibiotic prophylaxis in elective colorectal surgery

Gul, Yunus A.; Lian, Lee H.; Jabar, Faisal; Moissinac, K

doi:10.1046/j.1445-2197.2002.02365.x

Cited by 17 publications

(4 citation statements)

References 15 publications

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“…42 A survey conducted among Malaysian general surgeons (n = 96) found 40 respondents (42%) claimed that their basis of drug scheduling was influenced by medical literature. 41 However, of these 40 surgeons, only 9.5% administered a single dose of prophylactic antibiotic. Other factors affecting their drug scheduling was hospital guidelines (32%), personal preference (22%) and similar scheduling by colleagues (4%).…”

Section: Studies Exploring Surgeons' Adherence To Sap Guidelinesmentioning

confidence: 99%

“…Other factors affecting their drug scheduling was hospital guidelines (32%), personal preference (22%) and similar scheduling by colleagues (4%). 41 Around 30% of surgeons mentioned that there was no antibiotic policy at their hospital. This finding suggested that formal SAP protocols are either unavailable or poorly disseminated at their hospital.…”

Section: Studies Exploring Surgeons' Adherence To Sap Guidelinesmentioning

confidence: 99%

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surgeon's adherence to guidelines for surgical antimicrobial prophyllaxis- a review

Ng¹

2012

AMJ

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Surgical site infections are the most common nosocomial infection among surgical patients. Patients who experience surgical site infections are associated with prolonged hospital stay, rehospitalisation, increased morbidity and mortality, and costs. Consequently, surgical antimicrobial prophylaxis (SAP), which is a very brief course of antibiotic given just before the surgery, has been introduced to prevent the occurrence of surgical site infections. The efficacy of SAP depends on several factors, including selection of appropriate antibiotic, timing of administration, dosage, duration of prophylaxis and route of administration. In many institutions around the globe, evidence-based guidelines have been developed to advance the proper use of SAP. This paper aims to review the studies on surgeons' adherence to SAP guidelines and factors influencing their adherence. A wide variation of overall compliance towards SAP guidelines was noted, ranging from 0% to 71.9%. The misuses of prophylactic antibiotics are commonly seen, particularly inappropriate choice and prolonged duration of administration. Lack of awareness of the available SAP guidelines, influence of initial training, personal preference and influence from colleagues were among the factors which hindered the surgeons' adherence to SAP guidelines. Immediate actions are needed to improve the adherence rate as inappropriate use of SAP can lead to the emergence of a strain of resistant bacteria resulting in a number of costs to the healthcare system. Corrective measures to improve SAP adherence include development of guidelines, education and effective dissemination of guidelines to targeted surgeons and routine audit of antibiotic utilisation by a dedicated infection control team.

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Section: Studies Exploring Surgeons' Adherence To Sap Guidelinesmentioning

confidence: 99%

Section: Studies Exploring Surgeons' Adherence To Sap Guidelinesmentioning

confidence: 99%

surgeon's adherence to guidelines for surgical antimicrobial prophyllaxis- a review

Ng¹

2012

AMJ

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“…A similar situation or higher rates of surgical antimicrobial prophylaxis >24 h have been reported in other countries (range 52.8–77%) [ 11 , 12 , 20 , 21 , 22 ]. A survey conducted among general surgeons found that failure to keep up to date, reliance on habit rather than on evidence-based practices, personal experience and preference, peer influence, and institutional norms affected their choice of duration of antimicrobials cover [ 23 ]. Prolonging antimicrobial prophylaxis >24 h for most surgical procedures does not prevent the development of postoperative infections compared to recommended duration (24 h or less).…”

Section: Discussionmentioning

confidence: 99%

Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital

et al. 2021

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Antimicrobial resistance remains a significant public health issue, and to a greater extent, caused by the misuse of antimicrobials. Monitoring and benchmarking antimicrobial use is critical for the antimicrobial stewardship team to enhance prudent use of antimicrobial and curb antimicrobial resistance in healthcare settings. Employing a comprehensive and established tool, this study investigated the trends and compliance of antimicrobial prescribing in a tertiary care teaching hospital in Malaysia to identify potential target areas for quality improvement. A point prevalence survey method following the National Antimicrobial Prescribing Survey (NAPS) was used to collect detailed data on antimicrobial prescribing and assessed a set of quality indicators associated with antimicrobial use. The paper-based survey was conducted across 37 adult wards, which included all adult in-patients on the day of the survey to form the study population. Of 478 patients surveyed, 234 (49%) patients received at least one antimicrobial agent, with 357 antimicrobial prescriptions. The highest prevalence of antimicrobial use was within the ICU (80%). Agents used were mainly amoxicillin/β-lactamase inhibitor (14.8%), piperacillin/β-lactamase inhibitor (10.6%) and third-generation cephalosporin (ceftriaxone, 9.5%). Intravenous administration was ordered in 62.7% of prescriptions. Many antimicrobials were prescribed empirically (65.5%) and commonly prescribed for pneumonia (19.6%). The indications for antimicrobials were documented in the patients’ notes for 80% of the prescriptions; however, the rate of review/stop date recorded must be improved (33.3%). One-half of surgical antimicrobial prophylaxis was administered for more than 24 h. From 280 assessable prescriptions, 141 (50.4%) were compliant with guidelines. Treating specialties, administration route, class of antimicrobial, and the number of prescriptions per patient were contributing factors associated with compliance. On multivariate analysis, administering non-oral routes of antimicrobial administration, and single antimicrobial prescription prescribed per patient was independently associated with non-compliance. NAPS can produce robust baseline information and identifying targets for improvement in antimicrobial prescribing in reference to current AMS initiatives within the tertiary care teaching hospital. The findings underscore the necessity to expand the AMS efforts towards reinforcing compliance, documentation, improving surgical prophylaxis prescribing practices, and updating local antibiotic guidelines.

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“…While the adverse clinical impacts include increased hospital costs borne by the patients, the adverse clinical impacts include the occurrence of surgical site infections, prolonged hospital stay, increased consumption of antibiotics, the emergence of antibiotic resistance, morbidity and mortality (75,76). Also, previous studies have shown that in the absence of guidelines the prescribing patterns of physicians for SAP tend to be based on diverse rationales such as personal preferences, medical literature (77), discussions with colleagues (78) etc. In addition, there is a misconception among some surgeons that prolonged regimens with multiple antibiotics are more effective than short courses of narrow-spectrum antibiotics in reducing or eliminating the risk of surgical site infections (79).…”

Section: Challenges Regarding the Practice Of Surgical Antibiotic Pro...mentioning

confidence: 99%

A review of the practice of surgical antibiotic prophylaxis

Otaigbe

2023

Babcock Univ. Med. J.

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Background: Surgical Antibiotic Prophylaxis (SAP) is defined as the use of antibiotics to prevent infections at a surgical site. The appropriate use of SAP is an effective and efficient modality of preventing surgical site infections. Main body: The practice of SAP is however fraught with several challenges e.g., diverse opinions among surgeons regarding the duration of surgical prophylaxis, a dearth of institutional guidelines, and poor compliance with existing guidelines. Unfortunately, the inappropriate use of SAP results in adverse clinical (e.g., increased length of hospitalization, occurrence of surgical site infections, morbidity, etc.) and economic consequences (e.g., increased healthcare costs) in surgical patients. Conclusion: This review article discusses the practice of SAP and the challenges regarding SAP. Finally, some recommendations to overcome the challenges are discussed.

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Antibiotic prophylaxis in elective colorectal surgery

Cited by 17 publications

References 15 publications

surgeon's adherence to guidelines for surgical antimicrobial prophyllaxis- a review

surgeon's adherence to guidelines for surgical antimicrobial prophyllaxis- a review

Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital

A review of the practice of surgical antibiotic prophylaxis

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