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

Abstract

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.

Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia

“…One of the key factors is inappropriate and excessive prescription of antibiotics, including carbapenems, in the health care setting. Studies on inpatient prescription of antibiotics have been performed and published in half of the South and Southeast Asian countries, and excessive and inappropriate prescription of antibiotics in the inpatient setting has been highlighted as a major issue, ranging from between 10% to 50% of all antibiotics prescribed (97,141,(163)(164)(165)(166)(167)(168)(169). It is unlikely that the situation is better in the other countries (Bangladesh, Sri Lanka, Maldives, Bhutan, Afghanistan, Philippines, Myanmar, Laos, Cambodia, and Timor-Leste), where data are not available.…”

Understanding antibiotic decision making in surgery—a qualitative analysis

“…A major proportion of the antibiotics prescribed within hospitals is for surgical patients [1e3]. Inappropriate antibiotic prescribing in surgery is widely reported, with patients at risk of receiving prolonged durations of antibiotics for prophylactic and therapeutic indications [2,3]. In addition, postoperative infections remain one of the most common and costly hospital-acquired infections, and are associated with significant morbidity and mortality [4e8].…”

Antibiotic use among older adults on an acute care general surgery service

“…[26][27][28][29] Research investigating antibiotic use is extensive, and recent studies continue to show disappointing rates of prophylactic antibiotic use across various patient populations. 8,[30][31][32][33][34] We found that prophylactic antibiotic errors were common in the acute care general surgery setting. This is disappointing, given that surgical "time outs" before incision were in use at the time of this study.…”

“…The most frequent error was inappropriate timing, particularly the delayed administration of antibiotics after incision, which has been a common trend in prior studies. [30][31][32] Circumstances surrounding acute surgical care, including communication between surgical staff and anesthesiologists, compliance with checklists, competing care priorities and quick transitions from the ED to the OR may be factors involved in such errors. Barriers to provision of appropriate prophylaxis identified in the literature include a perceived low importance and inconvenience, impaired workflow, and organizational communication.…”