Antimicrobial prophylaxis outside the operating theatre, an audit in a university hospital

Abstract

Background: The prophylactic use of antimicrobial agents to prevent infections in non-surgical situations has hardly been investigated. We investigate the extent, indications and appropriateness of antimicrobial prophylaxis given outside the operating room in a tertiary care hospital. Methods: Four point-prevalence surveys were conducted in which all inpatients on that day were screened for the use of prophylactic antimicrobials: medical prophylaxis, prophylaxis around non-surgical interventions and surgical prophylaxis given on the ward. The primary endpoint was the extent of prophylaxis relative to the total number of antimicrobial prescriptions. We also investigated per prescription the presence of a (local) protocol and adherence to these protocols. Results: We registered in total 1020 antimicrobial prescriptions, of which 317 (31.1%) were given as prophylaxis. 827/ 1020 were antibiotic prescriptions. Of these antibiotic prescriptions, 17.0% was medical prophylaxis, 2.7% prophylaxis around non-surgical interventions and 6.9% surgical prophylaxis administered on a ward. For medical antibiotic prophylaxis, a protocol was present in 125 of 141 prescriptions (88.7%); the protocol was followed in 118 cases (94.4%). For prophylaxis around non-surgical interventions and surgical prophylaxis on the wards, protocol presence and adherence rates were 59.1% and 92.3%, and 73.3% and 97.6% respectively. Of the 96 antiviral and 97 antifungal prescriptions, 42.7% and 57.8%, respectively, were medical prophylaxis, of which 95.1 and 96.3% were prescribed according to protocols respectively. Conclusions: Antimicrobial prophylaxis outside the operating theatre is responsible for a considerable part of total in-hospital antimicrobial use. For most prescriptions there was a protocol and adherence to the protocols was high. The main targets for improvement were prophylaxis around non-surgical interventions and surgical prophylaxis given on the ward.

Antimicrobial stewardship intervention for the clinical pathways improves antimicrobial prophylaxis in surgical or non‐surgical invasive therapies

“…A previous report showed that about one-third of all antimicrobial prescriptions administered outside the operating rooms being prophylaxis, 21 which is consistent with the present data…”

“…A previous report showed that about one‐third of all antimicrobial prescriptions administered outside the operating rooms being prophylaxis, which is consistent with the present data showing that the proportion of surgeries being performed in operating rooms was approximately 78%. The proportion of inappropriate antimicrobial prophylaxis use was 28.4% and the most common type of inappropriate use was prolonged administration, which is also consistent with previous reports . Therefore, we emphasise that revision of the clinical pathways successfully optimised this prolonged antibiotic use in both surgeries and non‐surgical invasive therapies.…”

“…High rates of inappropriate use of prophylactic antibiotics in surgery continue to be a problem. Furthermore, increasing use of antimicrobials for prophylaxis outside the operating theatre was known . A clinician‐focused educational intervention was previously demonstrated to have no substantial effect on overall adherence to the surgical antibiotic prophylaxis guidelines .…”

“…However, the compliance rate of the guidelines is low . Deelen et al reported a high adherence rate to protocols for antibiotic prophylaxis, despite lower guideline adherence . From these findings, revising clinical pathways—that is, optimising protocols for antibiotic prophylaxis—are an effective means of optimising antimicrobial prophylaxis.…”

“…Furthermore, increasing use of antimicrobials for prophylaxis outside the operating theatre was known. 21 A clinician-focused educational intervention was previously demonstrated to have no substantial effect on overall adherence to the surgical antibiotic prophylaxis guidelines. 22 To improve antimicrobial prophylaxis at our institution, we revised all clinical pathways involving antimicrobial prophylaxis considered to be inappropriate for antimicrobial use.…”