Appropriate Antibiotic Administration in Elective Surgical Procedures: Still Missing the Message

Gu, Yunus A.; Hong, Lim Chong; Prasannan, Subhita

doi:10.1016/s1015-9584(09)60272-4

Cited by 26 publications

(33 citation statements)

References 12 publications

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“…Similar studies conducted in other countries (8)(9)(10)(11)(12)(13)(14)(15)(16), revealed a high frequency of prescription of antibiotics when not required, inappropriate choice, and use of antibiotics for a prolonged duration. In the current study too, a similar prescription pattern was found, where 3rd generation cephalosporins were prescribed to all patients preoperatively.…”

Section: Discussionsupporting

confidence: 71%

Antibiotic Prescription Pattern in Surgical Wards of MGM Hospital, Kamothe

Sane¹,

Shahani²,

Kalyanshetti³

2018

Int J Infect

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Background: Surgical antimicrobial prophylaxis refers to a brief course of antibiotic given just before surgery. Surgical site infection increases the hospital stay and prophylaxis has the potential to shorten hospital stay and fasten return to normal activity after discharge from the hospital. Therefore, the present study was undertaken to observe and analyse antimicrobial prescription pattern in patients that had undergone surgery at a tertiary care hospital. Methods: This was a prospective case series study, with 200 patients irrespective of age or gender, presented to the surgical wards of a tertiary hospital and undergoing surgical intervention, conducted from October 2016 to April 2017. Permission of the institutional ethics committee was obtained before commencement of the study. Data was collected from all patients with the help of predesigned, pretested, and structured questionnaires. By comparison with international guidelines and national guidelines, the antibiotic prescription patterns were assessed. The researchers also observed whether a fixed protocol was followed for antimicrobial use for surgical prophylaxis. Results: Overall, 200 patients were studied, with a mean age of 40.2 and a range of 23 to 70 years old with 64% being males and 36% being females. The surgeries of these patients were hernioplast 36%, PCNL 8%, haemorrhoidectomy 20%, appendicectomy 4%, hydrocoel surgery 16%, lipoma excision 12%, and cholecystectomy 4%. The percentages of antibiotics used for these surgeries were cefotaxime 44%, amikacin 88%, ceftriaxone 52%, metronidazole 30%, and cefixime 54%. These were then compared with the International and National guidelines for surgical prophylaxis. Conclusions: Third generation cephalosporins were the preferred antibiotics for pre-operative use as well as for use in combination with aminoglycoside and metronidazole for better postoperative antibiotic coverage. This seems to be due to multiple factors in Indian settings, which makes Indian practitioners administer antibiotics for a prolonged duration.

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Section: Discussionsupporting

confidence: 71%

Antibiotic Prescription Pattern in Surgical Wards of MGM Hospital, Kamothe

Sane¹,

Shahani²,

Kalyanshetti³

2018

Int J Infect

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“…However, other articles showed results inferior to the aforementioned frequencies, with a variation for the use of the antibiotic prophylaxis in the range of 58% to 73% [17][18][19] .…”

Section: Resultsmentioning

confidence: 99%

“…Intermediate values have been reported for this outcome, between 61.1% and 84% 18,20,21,23,28 . However, Gul et al 19 and Tourmousoglouv et al 16 observed rates of 98% and 100%, respectively, representing appropriate values. The timing of administration of prophylactic antibiotics should obey the time it takes to reach the blood and tissue concentrations that exceed the minimum inhibitory concentration for the microorganisms likely to colonize the surgical site 31,32 .…”

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confidence: 95%

Assessment of antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital.

Gouvêa

Novaes

Iglesias

2016

Rev. Col. Bras. Cir.

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Assessment of antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital. Avaliação da antibioticoprofilaxia em pacientes cirúrgicos no HospitalUniversitário Gaffrée e Guinle. This complication is one of the main forms of infections related to health care in Brazil, as demonstrated in a study conducted by the Ministry of Health, which observed SSI in 11% of all surgical procedures analyzed 4 . SSI occupies the third place in frequency among all the others, accounting for about 15% of all infectious processes observed in hospitalized patients 2,5 .Moreover, this type of complication involves financial burden to the patient, to the hospital and to the healthcare system. These facts make SSI an important public health problem and therefore a target for improving the quality of care to the patient who is candidate to surgical treatment 6 .Antibiotic prophylaxis is part of a set of measures that aim to reduce SSI incidence. The main aim of antibiotic prophylaxis is to reduce the bacterial load in the wound, to assist the natural host defenses in preventing SSI Efforts have been undertaken to establish protocols to guide the appropriate use of antibiotic prophylaxis for SSI prevention, whose goal is to provide health professionals with a standardized approach to the safe, effective and rational use of antimicrobials 9 .The aim of this study was to evaluate the use of antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital, in the city of Rio de Janeiro. Gouvêa Assessment of antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital METHODSThis is a prospective study of a cohort composed of patients undergoing elective surgical procedures between January and September 2014. Of the 283 patients who were initially candidates to participate in the study, we excluded 27 because they do not meet the established criteria, the final sample thus comprising 256 cases.We conducted the study at the Gaffrée e Guin- The sample calculation considered the likelihood of appropriate use of antibiotic prophylaxis to 50%, with 95% confidence interval, and type I error <5%.Thus, the estimated sample of 232 patients.Data collection included three different times:preoperative time, perioperative one and up to the seventh postoperative day; we performed the record in a standardized form. In cases of administered antibiotic, we STATISTICAL ANALYSISWe performed univariate analyzes by means of simple frequencies in order to describe the study sample, and bivariate analysis to detect differences in the distribution of independent variables for each outcome of interest, using the chi-square test. We also employed multivariate logistic regression, including the indepen- RESULTSThe characteristics of the sample represented by the 256 patients studied and the analyzed outcomes are shown in Tables 1, 2 and 3. Most patients were female (64.8%). The age ranged from 19 to 90 years, with a mean age of 52.9±16.2 and with a predominance of non-elderly (62.1%).Rega...

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“…Several studies assessing compliance with surgical prophylaxis guidelines in hospitals abroad have been published [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Overall compliance to guidelines has varied from as low as 0-53%, usually in the range of 20-30%.…”

Section: Discussionmentioning

confidence: 99%

How good is compliance with surgical antibiotic prophylaxis guidelines in a tertiary care private hospital in India? A prospective study

Parulekar¹,

Soman

Singhal

et al. 2009

Indian J Surg

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Purpose There is a need to study compliance with surgical antibiotic prophylaxis guidelines in India.Methods In this prospective study, 100 consecutive surgical procedures performed at a tertiary care private hospital in Mumbai, India were observed. The choice of antibiotic, timing and duration of administration were recorded and compared to the hospital guidelines.Results Appropriateness of choice of antibiotic was seen in 68%, timing in 89%, dose in 75% and duration in 63% of cases. Hundred percent compliance to all criteria was observed in 52% of cases. The SSI rate was 3.3%.Conclusions These compliance rates though suboptimal are similar to those reported in world literature. There is an urgent need to improve compliance with optimal surgical antibiotic prophylaxis guidelines so as to reduce risk of SSI and to prevent resistance and costs potentially associated with antibiotic misuse.

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Appropriate Antibiotic Administration in Elective Surgical Procedures: Still Missing the Message

Cited by 26 publications

References 12 publications

Antibiotic Prescription Pattern in Surgical Wards of MGM Hospital, Kamothe

Antibiotic Prescription Pattern in Surgical Wards of MGM Hospital, Kamothe

Assessment of antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital.

How good is compliance with surgical antibiotic prophylaxis guidelines in a tertiary care private hospital in India? A prospective study

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