Adherence to international and national recommendations for the prevention of surgical site infections in Italy: Results from an observational prospective study in elective surgery

Durando, Paolo; Bassetti, Matteo; Orengo, Giovanni; Crimi, Paolo; Battistini, Angela; Bellina, Dorotea; Talamini, Antonella; Tiberio, Gabriella; Alicino, Cristiano; Iudici, Rocco; Sticchi, Camilla; Ansaldi, Filippo; Rossi, Anna; Rosso, Rita; Viscoli, Claudio; Icardi, Giancarlo

doi:10.1016/j.ajic.2011.11.016

Cited by 31 publications

(53 citation statements)

References 21 publications

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“…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: 97%

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: 97%

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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“…However, this result is close to those found by other authors, whose rates varied between 81% and 88.1% 16,17,20,27 . The results from Pittalis et al 15 were material, with justification in 95% of cases, while Durando et al 28 found 70.3%. Nonetheless, Mahdaviazad et al 21 and Askarian et al 24 showed results inferior to those already mentioned, represented respectively by 35.4% and 2% of the cases.…”

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confidence: 81%

“…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.…”

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confidence: 99%

“…The result of multivariate analysis suggests that the outcome could not be associated with any independent variable, since there was no significant variability in this outcome frequency, that is, discontinuation of the antibiotic was performed in due time in most patients (95.7% cases). However, Wright et al 27 noted that groups of patients who more often received antibiotics for a long time were those with more comorbidities or elderly females.Surgical antibiotic prophylaxis may be considered appropriate when it reaches values of the criteria established in the adopted protocols close to 100%.From 11 analyzed articles that addressed appropriate surgical antibiotic prophylaxis, this parameter was considered inadequate in 100% of them [14][15][16][17]20,21,[23][24][25]28,30 . In their systematic review of adherence to surgical antibiotic prophylaxis protocols, Gouvêa et al 35 concluded that all the studies reviewed indicated the need for greater adherence to such protocols.…”

mentioning

confidence: 99%

“…From 11 analyzed articles that addressed appropriate surgical antibiotic prophylaxis, this parameter was considered inadequate in 100% of them [14][15][16][17]20,21,[23][24][25]28,30 . In their systematic review of adherence to surgical antibiotic prophylaxis protocols, Gouvêa et al 35 concluded that all the studies reviewed indicated the need for greater adherence to such protocols.…”

mentioning

confidence: 99%

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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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Utilization of surgical antibiotic prophylaxis for obstetrics and gynaecology surgeries in Northern Nigeria

2018

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Background Audit of antibiotic prophylaxis is an important strategy used to identify areas where stewardship interventions are required. Objectives To evaluate compliance with surgical antibiotic prophylaxis in obstetrics and gynaecology surgeries and determine the Defined Daily Dose (DDD) of antibiotic. Settings Three public tertiary hospitals located in Northern Nigeria. Methods This prospective study included women who had obstetrics and gynaecology surgeries with no infection at the time of incision. Appropriateness of antibiotic prophylaxis was determined by a clinical pharmacist. DDD of antibiotics was determined using ATC/DDD index 2017 from the World Health Organization Collaborating Centre for Drugs Statistics Methodology. Main outcome measure Compliance with antibiotic prophylaxis and DDD of antibiotic per procedure. Results A total of 248 procedures were included (mean age: 31.7 ± 7.9 years). Nitroimidazole in combination with either beta-lactam/beta-lactamase inhibitor or third generation cephalosporin were the most prescribed antibiotics. Redundant anaerobic antibiotic combination was detected in 71.4% of the procedures. Timing of antibiotic prophylaxis was optimal in 16.5% while duration of prophylaxis was prolonged in all the procedures (mean duration was 8.7 ± 1.0 days). The DDD of antibiotics prophylaxis was 16.75 DDD/procedure. Antibiotic utilisation was higher in caesarean section and myomectomy (17.9 DDD/procedure) than hysterectomy (14.5 DDD/procedure); P < 0.001. Redundant metronidazole represents one-third of total DDD and 87% of the DDD for metronidazole. Conclusion Excessive and inappropriate use of antibiotic prophylaxis was observed in women who had obstetrics and gynaecology surgeries. These observations underline the need for antimicrobial stewardship interventions to improve antibiotic use.

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Adherence to international and national recommendations for the prevention of surgical site infections in Italy: Results from an observational prospective study in elective surgery

Cited by 31 publications

References 21 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

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

Utilization of surgical antibiotic prophylaxis for obstetrics and gynaecology surgeries in Northern Nigeria

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