An audit of perioperative antimicrobial prophylaxis: Compliance with the international guidelines

Abstract

Objective:Antimicrobial prophylaxis has been demonstrated to lower the incidence of postoperative infection in nearly all types of surgery. The American Society of Health-System Pharmacists (ASHP) guideline summarizes current data on the appropriate use of antibiotic for surgical prophylaxis. The objective of this study was to assess and audit the use of antibiotics in a tertiary care center according to the recommendation of ASHP guideline.Methods:This cross-sectional study was performed using prospective data gathered from April to September 2015 in the surgical wards of Al Zahra Hospital, Isfahan, Iran. Antibiotic indication and choice, dose, dosing interval, route of administration, and timing of first administration and duration of prophylaxis were compared with the ASHP guideline recommendations.Findings:A total of 100 patients with the mean age of 49.8 ± 18.2 years were recruited for this study. About 22% of procedures had full compliance with all guideline recommendations. The most frequently encounter noncompliance type were the duration of prophylaxis (14%) and appropriate agent choice (35%). Timing of the initial dose was appropriate in most of the procedures (42%).Conclusion:This study revealed that most of the prescribed antibiotics for surgical prophylaxis are not in accordance with standard treatment guideline. The density of antimicrobial use for preoperative antimicrobial prophylaxis is very high. Furthermore, the hospital should develop a formal strategy, including a local guideline for antimicrobial prophylaxis in surgical procedures.

Fear and hierarchy: critical influences on antibiotic decision-making in the operating theatre

“…Surgical antibiotic prophylaxis (SAP) is a high-volume area of prescribing with significant rates of inappropriate prolonged prescription and compliance issues with timing, choice and dose. [1][2][3][4][5][6][7][8]. Inappropriate SAP represents a short-term risk to patients, via unnecessary use, and mid to longterm risks in terms of contributing to antimicrobial resistance, and is therefore logical to target for optimisation of prescribing within hospitals.…”

Antibiotic utilization pattern for surgical site infection prophylaxis at Dil Chora Referral Hospital Surgical Ward, Dire Dawa, Eastern Ethiopia

“…Report indicates that between 30 and 90% of this antibiotics prophylaxis use is inappropriate [ 10 , 11 ]. Inappropriate use specifically in the area of the antimicrobial selection, timing and the duration of the antimicrobial prophylaxis were commonly observed [ 12 – 14 ]. Inappropriate usage could leads to increased hospital costs, emergence of resistant microorganisms, and super-infections and increased adverse drug reaction [ 15 ].…”

Adherence to American Society of Health‐System Pharmacists guidelines for antibiotic prophylaxis in thoracic surgery: a prospective observational study

“…The results of a recent study in referral hospitals in Iran suggested that the most frequent microorganisms developing SSIs ( S. aureus , Escherichia coli and coagulase‐negative staphylococci) match those identified in US hospitals . Thus, using ASHP guidelines in our region is logical; however, the feasibility of this guideline needs to be documented . Finally, the nurse in charge of administering a patient's medications recorded the time of administration on paper notes.…”

“…30 Thus, using ASHP guidelines in our region is logical; however, the feasibility of this guideline needs to be documented. 31 Finally, the nurse in charge of administering a patient's medications recorded the time of administration on paper notes. Administration documentation error by nursing staff is a potential confounding factor in this study.…”