Non-compliance with recommendations for the practice of antibiotic prophylaxis and risk of surgical site infection: results of a multilevel analysis from the INCISO Surveillance Network

Miliani, Katiuska; L’Hériteau, F.; Astagneau, Pascal

doi:10.1093/jac/dkp367

Cited by 106 publications

(91 citation statements)

References 30 publications

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“…Studies conducted in Asian countries have generally reported higher prevalence of inappropriate antibiotic use for prophylaxis (48-100%) when compared to developed countries (23.4%-55.2%) [15,16,17,18,19]. Inappropriate timing of antibiotic administration (36.4%) and inappropriate duration (34.5%) were found to be the main reasons for inappropriate prophylactic antibiotic which was also similar to previous studies [17,18,20]. The inappropriate timing of administration in our setting was most likely due to the lack of local institutional guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…The 16 (19.3%) courses of antibiotics given post-operatively may reflect a practice that could be easily targeted for intervention. Unnecessarily prolonging the duration of prophylaxis does not necessarily lead to better outcomes, but instead predisposes to selective pressure for resistant bacteria [18].…”

Section: Discussionmentioning

confidence: 99%

“…Contrary to this, many developed countries prefer the use of first generation cephalosporins or a combination of penicillin and betalactamase-inhibitors [18,20,23,24,25]. Studies, however, have shown no difference between the use of broad spectrum and narrow spectrum prophylactic antibiotics in terms of lowering rate of SSI [12].…”

Section: Discussionmentioning

confidence: 99%

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Antibiotics in surgical wards: use or misuse? A newly industrialized country’s perspective

Lim

Lai

Ponnampalavanar

et al. 2015

J Infect Dev Ctries

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Introduction: Studies exploring the appropriateness of therapeutic antibiotic use among surgical patients are limited, particularly in developing countries. Therefore, the aim of our study was to determine the appropriateness of antibiotics prescribed in a surgical setting in Malaysia. Methodology: A prospective observational study was conducted in two surgical wards at a tertiary hospital in Malaysia from November 2012-July 2013. Data was collected using a case report form. The appropriateness of antibiotic therapy was based on compliance with either the Malaysian National Antibiotic Guidelines 2008 or International Clinical Practice Guidelines and determined by an expert panel (consisting of two infectious disease consultants and a pharmacist). Results: Over the study period, a total of 593 antibiotic courses were prescribed for 129 patients (4.6±3.4 antibiotics/patient). Only 34 (26.4%) patients received appropriate antibiotic therapy, whilst 95 (73.6%) patients received at least one course of inappropriate antibiotic therapy. The prevalence of inappropriate antibiotic use was 214 (66.3%) and 55 (42.0%) for prophylactic and therapeutic purposes, respectively. The most common causes of inappropriate prophylactic antibiotics were inappropriate timing 20 (36.4%) and inappropriate duration of prophylaxis 19 (34.5%). In cases of inappropriate timing, 9 (45%) were administered too late while 6 (30%) were too early. . In contrast, inappropriate choice of antibiotics (42.1%) and inappropriate indication (40.7%) were the most common reasons encountered for inappropriate therapeutic antibiotics. Conclusion: Our study suggests considerable inappropriate use of both prophylactic and therapeutic antibiotics in the surgical wards; highlighting an urgent need for antibiotic stewardship initiatives in this setting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Antibiotics in surgical wards: use or misuse? A newly industrialized country’s perspective

Lim

Lai

Ponnampalavanar

et al. 2015

J Infect Dev Ctries

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“…14 The compliance to these recommendations was low in both time periods. Although the rate is comparable with other published data, 15 measures should be implemented to improve adequate redosing.…”

Section: Discussionmentioning

confidence: 96%

Successful Implementation of a Window for Routine Antimicrobial Prophylaxis Shorter than That of the World Health Organization Standard

Misteli

Widmer

Weber

et al. 2012

Infect. Control Hosp. Epidemiol.

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OBJECTIVE. To evaluate the feasibility of implementation of the refined window for routine antimicrobial prophylaxis (RAP) of 30-74 minutes before skin incision compared to the World Health Organization (WHO) standard of 0-60 minutes.DESIGN. Prospective study on timing of routine antimicrobial prophylaxis in 2 different time periods.SETTING. Tertiary referral university hospital with 30,000 surgical procedures per year.METHODS. In all consecutive vascular, visceral, and trauma procedures, the timing was prospectively recorded during a first time period of 2 years (A; baseline) and a second period of 1 year (B; after intervention). An intensive intervention program was initiated after baseline. The primary outcome parameter was timing; the secondary outcome parameter was surgical site infection (SSI) rate in the subgroup of patients undergoing cholecystectomy/colon resection.RESULTS. During baseline time period A (3,836 procedures), RAP was administered 30-74 minutes before skin incision in 1,750 (41.0%) procedures; during time period B (1,537 procedures), it was administered in 914 (56.0%; P<.001). The subgroup analysis did not reveal a significant difference in SSI rate.CONCLUSIONS. This bundle of interventions resulted in a statistically significant improvement of timing of RAP even at a shortened window compared to the WHO standard. Infect Control Hosp Epidemiol 2012;33(9):912-916Surgical site infections (SSIs) significantly impact morbidity and mortality and represent a leading cause of healthcareattained infection. 1 " 3 Appropriate perioperative antimicrobial prophylaxis can reduce the incidence of SSI. 4 " 6 Today, singleshot administration of a first-or second-generation cephalosporin is the state-of-the-art procedure in routine antimicrobial prophylaxis (RAP), 7 supplemented with metronidazole in colorectal surgery for anaerobic coverage. In addition to the type of antibiotic, the timing of RAP in relation to skin incision is crucial. Based on the findings of the landmark publication in 1992 by Classen et al, 8 guidelines recommend the administration of RAP within 2 hours before skin incision, whereas the 2008 World Health Organization (WHO) guidelines for safe surgery support administration within 1 hour before skin incision. 9 In a prospective cohort study of 6,540 interventions, administration of RAP 30-74 minutes before skin incision achieved the lowest SSI risk. 10

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“…Lack of necessary prophylactic redosing has been reported as a significant risk factor for SSI in various surgical fields (19,25), while continuing prophylaxis for more than 24 hours postoperatively was found to be of no additional protective benefit (10,17,18). Some studies showed prolonged antibiotic prophylaxis was correlated with an increased risk of acquired antibiotic resistance (10, 11).…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial prophylaxis at neurosurgical department of a major hospital in china: compare of cross sectional studies

Yang²,

He³

et al. 2014

Turkish Neurosurgery

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AIm:To compare the effects of post neurosurgical antimicrobial prophylaxis before and after the adoption of a new protocol in our department, which changed from prolonged prophylaxis to limited usage. mATERIAL and mETHods: Two cross-sectional studies were performed to compare the 24-hour antimicrobial use for all the inpatients at the neurosurgical ward 1 day before (June 30, 2011) and 1 year after (June 29, 2012) the beginning of the new rules. Student's t-test or the chisquare test were used to compare baseline characteristics and prophylactic or therapeutic antimicrobial usage between the groups. REsuLTs:The total of 391 patients enrolled consisted of 221 for June 30, 2011 as group 1 and 170 for June 29, 2012 as group 2. The baseline characteristics of the groups showed no significant difference. The prophylactic use significantly decreased in Group 2 (13.1% vs. 5.9%, p=0.018). However, total therapeutic use (10.9% vs. 18.2%, p=0.041) and the use for nosocomial infection (7.32% vs. 15.9%, p=0.009) both increased significantly in Group 2. Furthermore, therapeutic use for surgical site infections also increased significantly (3.16% vs. 9.41%, p=0.015).CoNCLusIoN: Shorter antimicrobial prophylaxis may increase post neurosurgical infection. The optimal duration of neurosurgical antimicrobial prophylaxis should be compliant with local hospital conditions and further prospective trials are required to address this issue on a procedure-specific basis.KEywoRds: Antimicrobial prophylaxis, Neurosurgery, Cross-sectional study ÖZ AmAÇ: Uzun süreli profilaksiden kısıtlı kullanıma geçecek şekilde bölümümüzde yeni bir protokolün kabullenilmesinden önce ve sonra nöroşirürji sonrasında antimikrobiyal profilaksinin etkilerini karşılaştırmak. ,9, p=0,018). Ancak nozokomiyal enfeksiyon için kullanım (%7,32 ve %15,9, p=0,009) ve total terapötik kullanım (%10,9 ve %18,2, p=0,041) değerlerinin her ikisi Grup 2'de önemli ölçüde arttı. Ayrıca, cerrahi bölge enfeksiyonları için terapötik kullanım da önemli ölçüde arttı (%3,16 ve %9,41, p=0,015). soNuÇ: Daha kısa antimikrobiyal profilaksi nöroşirürji sonrası enfeksiyonu artırabilir. Nöroşirürji için antimikrobiyal profilaksinin optimum süresi yerel hastane koşullarına uymalıdır ve bu konuyu spesifik bir temelde ele almak için ek prospektif çalışmalar gereklidir.ANAHTAR sÖZCÜKLER: Antimikrobiyel profilaksi, Nöroşirürji, Çapraz kesit çalışması

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Non-compliance with recommendations for the practice of antibiotic prophylaxis and risk of surgical site infection: results of a multilevel analysis from the INCISO Surveillance Network

Abstract: A too-short SAP duration was the most important SAP malpractice associated with an increased risk of SSI. Information directed at practitioners should be reinforced based on standard recommendations.

Cited by 106 publications

References 30 publications

Antibiotics in surgical wards: use or misuse? A newly industrialized country’s perspective

Antibiotics in surgical wards: use or misuse? A newly industrialized country’s perspective

Successful Implementation of a Window for Routine Antimicrobial Prophylaxis Shorter than That of the World Health Organization Standard

Antimicrobial prophylaxis at neurosurgical department of a major hospital in china: compare of cross sectional studies

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