Application of ATC/DDD methodology to evaluate perioperative antimicrobial prophylaxis

Akalın, Şerife; Kutlu, Selda Sayın; Çırak, Bayram; Eskiçorapçı, Saadettin; Bağdatlı, Dilek; Akkaya, Semih

doi:10.1007/s11096-011-9601-3

Cited by 16 publications

(20 citation statements)

References 21 publications

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“…However because of lack of protocols, and hospital supply availability of antibiotics, personal judgments of treating physicians may explain the tendency to use broad spectrum or combination antibiotics and to continue use beyond 24 hours in our study. These findings are shared with Jordanian study which found that neither antibiotic choice(1.7%) nor duration(39.4%) were appropriate [12], the Turkish study [9] which also found that prolonged antibiotics prophylaxis was used in 56.9%, however the US study where protocols are usually followed showed excellent compliance (92.6%) in antibiotic selection [14]. …”

Section: Discussionmentioning

confidence: 82%

“…Low adherence is shared by other studies in the region; For example the Jordanian study found that none of the observed cardiac operations was adherent to all antimicrobial prophylaxis guidelines with wide variation in adherence to selected parameters studied [12]. The Iranian study also found only one surgical procedure of the observed 155 to be adherent to all parameters of prophylaxis guidelines with varying degrees of compliance in different parameters [13], and the Turkish study found only 13.7% of the perioperative antibiotic prophylaxis given were appropriate and correct [9]. …”

Section: Discussionmentioning

confidence: 99%

“…There is evidence that appropriate use of antibiotic in surgery is effective in decreasing mortality and health care costs associated with infections developed after surgery [8,9]. …”

Section: Introductionmentioning

confidence: 99%

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Adherence to guidelines of antibiotic prophylactic use in surgery: a prospective cohort study in North West Bank, Palestine

2014

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BackgroundSurgical site infection is a major contributor to increased mortality and health care costs globally which can be reduced by appropriate antibiotic prophylactic use. In Palestine, there is no published data about preoperative antibiotic use. This study aims to find the pattern of antimicrobial prophylaxis use by evaluating time of the first dose, antibiotic selection and duration after surgery in three governmental hospitals in North West Bank/ Palestine during 2011.MethodsAfter approval of Institutional Review Board, a prospective cohort study included a total of 400 abdominal, orthopedic, and gynecological operations which were performed during study period. Trained clinical pharmacists observed selected 301 operations and followed the patient’s files for the three intended study parameters. Compliance of prophylactic antibiotic administration was evaluated according to published guidelines of the American Society for Hospital Pharmacist. Data were analyzed using SPSS version 16 applying descriptive methods. Relationship between guideline compliance and selected operation factors such as type of surgery, patient care unit, and hospital shift, in addition to provider’s age, gender, experience, and specialization were examined applying chi square test. The statistically significant factors with p < 0.01 were further analyzed using logistic regression model.ResultsOverall compliance for the studied parameters was very low (2%); only 59.8% received their first dose in appropriate time, 18.5% had appropriate antibiotic selection, and 31.8% of patients received antibiotic in appropriate duration. The OBGYN department had much better compliance regarding timing and duration of antibiotic use (P < 0.001), however the proper antibiotic selection was best adhered to for the abdominal surgeries (OR = 3.64, P = 0.002). Male providers were statistically significantly much less adherent to the timing of antibiotic dose (OR = 0.28, p < 0.001), but better adherent in antibiotic selection (OR = 0.191, p = 0.028). Anesthetic technicians showed higher compliance than nurses in timing and duration of antibiotic use.ConclusionsLack of guidelines explains the low adherence to appropriate surgical antibiotic prophylaxis in Palestine, with high rate of broad spectrum antibiotic use, long duration and inappropriate time of first dose .We recommend adopting guidelines for prophylaxis and training all health care providers accordingly.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Adherence to guidelines of antibiotic prophylactic use in surgery: a prospective cohort study in North West Bank, Palestine

2014

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“…The Anatomical Therapeutic Chemical (ATC) Classification System and the measurement unit of defined daily dose (DDD) [1] were recommended and officially regarded by the World Health Organization (WHO) as the international standard in drug utilization research (DUR) in 1996. The number of DDDs [2] and drug use density (DDDs per patient day [3], DDDs per 100 patient days [3][4][5][6], DDDs per 1000 patient days [7][8][9][10], DDDs per admission [3,11], DDDs per 1000 admissions [3,12,13], or DDDs per operation [14]) established based on the ATC/DDD system have been widely used as important indicators of antibiotic utilization research. However, although they can be obtained easily and applied to continuously and systematically monitor the administration of antibiotics in a population, these macro-indicators are not meaningful in evaluating the appropriateness of drug utilization.…”

Section: Introductionmentioning

confidence: 99%

From population to individuals: a new indicator for evaluating the appropriateness of clinical application of antibiotics

Liu

2018

BMC Pharmacol Toxicol

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BackgroundThis study aims to establish a new indicator based on the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system.MethodsUtilization data of antibiotics of inpatients in a university hospital were used to calculate the indicators of use rate (UR), use density (UD), and ratio of use density to use rate (UD/UR). According to the professional characteristics, the recommended values of UD/UR in different departments were established respectively. Crosswise comparison and appropriateness evaluation between different treatment groups with the same profession were performed. For individual inpatients with abnormally increased drug utilization index (DUI) and ratios of antimicrobial course to length of stay (C/S), detailed analysis was performed to examine whether any irrational drug utilization occurred.ResultsThe indicator UD/UR combines both dose and duration of treatment, which were the two main factors affecting the appropriateness of clinical application of antibiotics. Thus, it can more sensitively reveal the drug utilization of inpatients receiving antibiotics. UD/UR is also more suitable for evaluating the clinical appropriateness of antibiotic application than the macroscopic indicator, total UD, and could be applied at the macroscopic and microscopic levels.ConclusionsThe ratio UD/UR has great practical value and can serve as a reference for evaluating the appropriateness of clinical application of antibiotics.

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“…Therefore, almost surgery should be given prophylactic antibiotics to reduce the incidence of SSI. The use of appropriate antibiotic prophylaxis in surgery is quite effective in reducing mortality and health care costs associated with infection after surgery [3]. However, the compliance to surgical guidelines for antibiotic prophylaxis in some countries is still varies including in Indonesia [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Cross–sectional Study of Surgical Prophylactic Antibiotic Administration in Marzoeki Mahdi Hospital, Bogor, Indonesia

Rokhmah

Andrajati

Radji

2017

Asian J Pharm Clin Res

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Objective: This study was conducted to evaluate the prophylactic antibiotic administration in the surgical clinic of Dr. H. Marzoeki Mahdi Hospital, Bogor, Indonesia. Methods:The data were assessed from the medical records of all patients who underwent surgery from January to December 2013 retrospectively. Antibiotic prophylaxis was assessed based on the Scottish Intercollegiate Guidelines and the National Guidelines of Antibiotic Usage, which includes the type, time, and duration of prophylactic administration of antibiotics.Results: A total of 577 patients were included in this study, consisting of 202 men and 375 women. The most frequently performed surgery is a common surgery 347 (60.1%), followed by obstetric operations 176 (30.5%), and orthopedic surgery 54 (9.4%). In this study, all patients received prophylactic antibiotics before surgery. Cefotaxime (87.8%) was the most commonly used antibiotics for surgical prophylaxis. Of the 577 patients, only 1.1% of patients reported with surgical site infection (SSI). Conclusion:This study shows that adherence to the guidelines of surgical antibiotic prophylaxis is still very low. Therefore, efforts should be made to increase the compliance of using antibiotic prophylaxis in accordance with standard guidelines to improve the rational use of antibiotics.

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Application of ATC/DDD methodology to evaluate perioperative antimicrobial prophylaxis

Abstract: The density of antimicrobial use in PAP was found to be very high in our hospital. Antibiotic overuse extended into the postoperative period.

Cited by 16 publications

References 21 publications

Adherence to guidelines of antibiotic prophylactic use in surgery: a prospective cohort study in North West Bank, Palestine

Adherence to guidelines of antibiotic prophylactic use in surgery: a prospective cohort study in North West Bank, Palestine

From population to individuals: a new indicator for evaluating the appropriateness of clinical application of antibiotics

Cross–sectional Study of Surgical Prophylactic Antibiotic Administration in Marzoeki Mahdi Hospital, Bogor, Indonesia

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