Audit of antibiotic use in a Brazilian University Hospital

Abstract

A cohort study was carried out at the Marilia Medical School Hospital. In the first phase the pattern of antibiotic use was evaluated. Antibiotics were prescribed for 55.4% of the patients; antibiotic combinations were used in 43%. Therapeutic use of antibiotics was considered inadequate in 27%. Respiratory and skin infections were the most frequently diagnosed. In up to 31% of the cases the treatment of respiratory infections was considered inadequate. The surgical use of antibiotic prophylaxis was evaluated in the second phase. Prophylaxis was indicated in 73.2% of the surgeries. The antibiotics most used for prophylaxis were first generation cephalosporins. In 78.9% of the surgeries, the antibiotic was correctly chosen. In 15.9% of the surgeries, the initial antibiotic administration was correctly timed. The use of antibiotics in the post-operative period was appropriate in 29.8% of the cases. The independent risk factors for surgical site infection (SSI), as determined by logistic regression analysis adjusted to class of wound risk, were the choice of antibiotic to be used prophylactically and the duration of antibiotic treatment in the post-operative period. Those who received appropriate prophylactic antibiotics had a lower rate of SSI than those who received innapropriated antibiotics [RR=0.49/95%; CI=0.25-0.90]. Patients who received prophylactic antibiotics correctly in the post-operative period had a lower risk of SSI than those who did not [RR=0.21/95%; CI=0.70-0.63]. The mean length of hospital stay was shorter among patients whose prophylactic treatment was correctly employed than among for which it was not [6.1 (+/-9.8) and 11.1 (+/-13.5) days, p=0.25].

Preoperative antibiotic prophylaxis practice and guideline adherence in Jordan: a multi-centre study in Jordanian hospitals

“…Inappropriate timing may result in low plasma concentration of the antimicrobial agent at the time of incision and throughout the procedure [13], contributing to higher infection rates [14]. In contrast to other studies [8,15], our results indicated that 49% of physicians administered the SAP at the time of anesthesia induction. This is considered the correct timing according to ASHP guidelines for most procedures, since this ensures adequate antibiotic concentrations in the targeted tissues during the period of potential contamination [7].…”

Audit of Physicians’ Adherence to the Antibiotic Policy Guidelines in Kuwait

“…The misuse of antibiotics contributes to this dilemma [14]. In our study, the 25% nonindicated antibiotic prescriptions was within the range of 15.5–72% reported in other studies [15,16,17,18]. The unwarranted prescription of antibiotics among physicians could be due to inaccurate diagnosis, imprecise recognition of conditions that can be treated with antibiotics, and concerns of a poor clinical outcome when antibiotics are not given [19].…”

Prophylactic Antibiotics and Wound Infection

“…However; for other clean neck surgeries and hernia repair it is not recommended due to the low incidence of wound infection [15]. In Brazil Fonseca and Contemnor reported that 26% of patients were unnecessarily given antibiotics for surgical prophylaxis [16].…”