Evaluation of compliance with the antibiotic prophylaxis protocol in breast surgery and its effect on the incidence of surgical infection

Gil-Conesa, Mario; Martinez, Nicole; Luque, Javier; Póveda, Manuel Durán; Villar, D Rodríguez; Caravaca, G. Rodríguez

doi:10.23938/assn.0637

“…Compliance with PAP is an important factor in reducing the incidence of SSI and avoiding the costs associated with it [13]. As in other non-infected surgical acts, antibiotic prophylaxis is recommended for all caesarean deliveries unless the patient is already receiving an antibiotic regimen for another existing infectious entity [10,12,[14][15][16][17][18]. However, in our study only 569 patients (69.90%) received…”

Section: Discussionmentioning

confidence: 95%

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

Viamonte

¹

,

Tames²,

Correa

³

et al. 2020

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0

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Background Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. Methods A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. Results The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR=2.79, P=0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR=1.33, P=0.649). Also, a significant relationship was found between SSI and patient age (Chisq=8.08, P=0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. Conclusions Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

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“…La profilaxis antibiótica ha demostrado ser de gran utilidad en la reducción de las tasas de infección quirúrgica en diversas cirugías ginecológicas [9,11,12]. En nuestro estudio no ha resultado ser un factor con significación estadística para la reducción del riesgo, al igual que en diferentes trabajos precedentes realizados por nuestro equipo investigador en distintas localizaciones quirúrgicas [17,18,[22][23][24][25], lo que probablemente sea debido a la incidencia tan baja de ILQ en histerectomía y a la alta adecuación de la profilaxis antibiótica conseguida.…”

Section: Sobre El Total De Profilaxis Administradasunclassified

“…Como fortalezas del presente trabajo cabe destacar también que las pacientes fueron evaluadas durante un periodo de un mes tras el alta, con seguimiento de cualquier problema relacionado con la herida quirúrgica, tanto en Atención Primaria como en consultas externas y Urgencias, por lo que se trata de un estudio de alta evidencia. Para evitar sesgos por pérdidas en dicho seguimiento, al calcular el tamaño muestral se La estancia media hospitalaria aumentó de forma significativa en las pacientes con infección quirúrgica de nuestra serie, tal y como se observa también en diversos estudios similares realizados en nuestro centro [12,17,18]. Los bacilos gramnegativos E. coli y P. mirabilis fueron los microorganismos causantes de ILQ más frecuentes, lo que concuerda con otros trabajos anteriores en cirugía abdominal [17,19].…”

Section: Sobre El Total De Profilaxis Administradasunclassified

“…Numerosos estudios han establecido factores de riesgo para el desarrollo de ILQ en cirugías ginecológicas, destacando entre los factores modificables el tiempo quirúrgico, la adecuación de la profilaxis antibiótica o la preparación prequirúrgica [6,7,12]. Se estima que el 60% de las ILQ son prevenibles, esto se relacionaría principalmente con el uso de prácticas recomendadas basadas en la evidencia como la selección, tiempo de inicio y duración de los antibióticos preoperatorios [20].…”

Section: Sobre El Total De Profilaxis Administradasunclassified

“…La adecuación de la profilaxis antibiótica es una medida que ha demostrado reducir entre un 47% y un 56% las infecciones quirúrgicas [9,11,12]. Consiste en la administración de un antibiótico previo a la cirugía con el objeto de asegurar una concentración óptima en sangre y en los tejidos donde se va a realizar la intervención, durante el periodo desde la incisión hasta el cierre de la herida.…”

Section: Introductionunclassified

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Evaluation of compliance with the antibiotic prophylaxis protocol in hysterectomy. Prospective cohort study

Gil-Conesa¹,

Del-Moral-Luque²,

et al. 2020

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Objectives. Health care-related infections are a public health problem, among them surgical site infection (SSI) are the most frequent in hospitals. The objetive of this study was to assess the effect of the compliance to antibiotic prophylaxis protocol on the incidence of surgical site infection in hysterectomized patients. Material and methods. A prospective cohort study was carried out between October 2009 and December 2018. The incidence of SSI was studied after a maximum period of 30 days from the moment of surgery. The degree of adequacy of antibiotic prophylaxis in hysterectomy and the effect of its inadequacy on the incidence of infection was evaluated using relative risk (RR) adjusted with a logistic regression model. Results. A total of 1,025 interventions were studied in 1,022 women. The cumulative incidence of SSI was 2,1% (n = 22). The most frequent etiology of infection was Escherichia coli (23.1%) and Proteus mirabilis (23.1%). Antibiotic prophylaxis was indicated in 1,014 interventions (98.9%) being administered in 1,009 of them (99.5%). The adherence to the protocol was 92,5%. The main cause of non-compliance was the time of onset (40.9%), followed by the choice of the antibiotic (35.2%). The effect of inadequate prophylaxis on the incidence of infection was RR = 0.9; 95% CI 0.2-3.9; p> 0.05. Conclusions. The adequacy of antibiotic prophylaxis was very high, with a low incidence of surgical site infection. No association was found between adequacy of prophylaxis and incidence of infection in hysterectomy. The continuous improvement of epidemiological surveillance in gynecology should be emphasized.

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Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

Viamonte

¹

,

Tames²,

Correa

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. Methods A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. Results The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR=2.79, P=0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR=1.33, P=0.649). Also, a significant relationship was found between SSI and patient age (Chisq=8.08, P=0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. Conclusions Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

show abstract

Evaluation of compliance with the antibiotic prophylaxis protocol in breast surgery and its effect on the incidence of surgical infection

Cited by 4 publications

References 22 publications

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

Evaluation of compliance with the antibiotic prophylaxis protocol in hysterectomy. Prospective cohort study

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

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