Quantity and quality profiles of antibiotics pre, on, and post surgery in a hospital setting

Abstract

Background Providing proper antibiotics is undoubtedly crucial to prevent infections during surgery. Objective This study set out to evaluate the medication administration in antibiotic prophylaxis using both quantitative and qualitative methods. Setting The study employed a retrospective design and observed patients who underwent surgical procedures during hospitalization at a private hospital in Indonesia within the period of January-June 2019. Methods The data obtained were evaluated quantitatively and qualitatively; and analyzed descriptively. The quantitative evaluation used the defined daily dose (DDD) per 100 bed-days. The qualitative evaluation was expressed as the percentage of antibiotic suitability based on antibiotic administration, i.e. (1) type; (2) timing; (3) dosage; (4) duration; and (5) route. Main outcome measure Suitability of antibiotic prophylaxis in a hospital setting. Results There were 164 prescriptions recorded from 20 types of surgical procedures, of which the most common was cholecystectomy (23 patients, 14%). Most antibiotics were administered 61-120 min before the incision time (55 patients, 37%), and had a duration of more than 24 h (119 patients, 80%). The total DDD per 100 bed-days for pre-, on-, and post-surgery antibiotic use were 44.2, 33.3, and 66.7 respectively. The suitability profiles of the antibiotics used according to the Antibiotic Use Guideline for Hospital (2018) were as follows: 26.3% right type, 52.9% right time, 24.8% right dosage, 19.1% right duration, 91.8% right route, while according to American Society of Health-System Pharmacists Therapeutic Guidelines (2014) there were 17.6% right type, 53.4% right time, 16.4% right dosage, 19.1% right duration, and 96.6% right route. Conclusion Ceftriaxone was the first-choice prophylactic antibiotic administered in this Indonesian hospital. The data indicate a considerable non-compliance with local and international guidelines. Keywords Antibiotic prophylaxis • DDD per 100 bed-days • Inappropriate prescriptions • Surgery Impacts on practice• Evaluating antibiotic prophylaxis is useful for assessing the possibility of inappropriate antibiotic use. • Surgeons tend to prescribe prophylactic antibiotics for all types of surgery despite the absence of prerequisites for some of them.• Frequent inappropriate use of antibiotics can increase the cost of treatment and antibiotic resistance in patients. • Increasing adherence to guidelines and the use of appropriate prophylactic antibiotics are important points in prevention of surgical site infection and control of microbial resistance. • To increase adherence, training is needed to normalize antibiotic selection in accordance with international and local guidelines.

Optimizing antibiotic use in Indonesia: a systematic review and synthesis of current evidence to inform opportunities for intervention

“…A total of 20 reports (5 193 626 patients) reported data on antibiotic consumption. 19–38 Most of the studies were conducted in hospital settings (16 reports, 76.2%), in Java (14 reports, 66.7%), and between 2016-2021 (17 reports, 81.0%; Table S4 ). The pooled estimate of overall antibiotic consumption was 110.1 DDD/100 patient-days (95% confidence interval [CI] 98.5-121.6; I 2 =100%; Figure S1 ), with ceftriaxone being the most consumed antibiotic (60.2 DDD/100 patient-days [95%CI 34.2-86.1]), followed by ampicillin (28.0 DDD/100 patient-days [95%CI 0.00-82.8]) and levofloxacin (21.4 DDD/100 patient-days [95%CI 15.4-27.3]; Figure 3 ).…”

“…A total of 20 reports (5 193 626 patients) reported data on antibiotic consumption. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Most of the studies were conducted in hospital settings (16 reports, 76.2%), in Java (14 reports, 66.7%), and between 2016-2021 (17 reports, 81.0%; Table S4). The pooled estimate of overall antibiotic…”

Sustained Improvement of Appropriateness in Surgical Antimicrobial Prophylaxis with the Application of Quality Control Circle

“…8,9 However, unnecessary or suboptimal prescriptions of antimicrobial prophylaxis is a common phenomenon worldwide, including excessive use of antibiotics, inappropriate selection or dosages, prolonged duration or incorrect timing of first dose, which may result in antibiotic resistance and higher healthcare costs. 10 Quality control circle (QCC) is a process management and problem-solving technique founded in 1962 by Dr Kaoru Ishikawa of Japan, which is viewed as a powerful tool to solve the problems in work and improve the complex work flow by the joint efforts of all members composed of staff from the same or similar complementary workplaces. 11 Until 2001, QCC activities was introduced to healthcare industry in China, and numerous studies have revealed that the application of QCC could effectively raise the quality of medical service and ensure the safety of patients.…”

Appropriateness and adherence to guidelines in perioperative antimicrobial prophylaxis in patients undergoing clean surgery: results from a Quality Control Circle intervention

“…Although perioperative antimicrobial prophylaxis (PAP) guidelines across a wide array of surgical procedures have been proposed [8,9]. Still, suboptional use of antimicrobial for surgical prophylaxis is a common phenomenon worldwide, such as without indication, inappropriate selection or dosing of antimicrobial agents, prolonged duration of antimicrobial agents, incorrect timing of prophylaxis, which may result in AMR and higher healthcare costs [10].…”