Evaluation of Antibiotic Prophylaxis and Discharge Prescriptions in the General Surgery Department

Abstract

Introduction Although there are international guidelines for surgical antibiotic prophylaxis (SP), the use of inappropriate SP is still a common problem. Most studies investigated SP applications in clean and clean-contaminated cases. However, antibiotics in the discharge prescriptions of these cases have not been adequately investigated. In this study, we aimed to examine the antibiotics in SP applications and discharged prescriptions together and to find out the causes of inappropriate use. Materials and methods We retrospectively evaluated the data of patients admitted to our general surgery wards between 2014 and 2015. Patients with clean or clean-contaminated wound category operations were included. The patients were evaluated in terms of convenience of SP (choice of antibiotics, compliance with an indication for SP, timing of the first dose, SP>24 hours, and discharge prescription). In addition, to interpret the results, a questionnaire has been performed for the surgeons in the same clinics. Results A total of 1205 patients with clean and clean-contaminated wound class operation were enrolled in this study. The total accuracy rate of SP was 7.1%. SP application with the correct indication and timing of the first dose was compatible with guidelines: 55.6% and 81.9%, respectively. SP was applied >24 hours at 60.2% and antibiotic prescribing carried out after discharge at 80.6% of patients. According to questionnaire results, the use of SP over 24 hours and the prescription of antibiotics during discharge were: drain usage, hyperthermia, leukocytosis, surgeons feeling of comfort, avoidance of patients, and their relatives' reactions. Conclusion The total accuracy rate of SP rate was low in the present study and in surgeons prescribing the SP after discharge. In light of the present study, we suggest that discharge prescriptions should also be reviewed in clinics who have a high inappropriate surgical antibiotic prophylaxis rate.

A new antibiotic stewardship program approach is effective on inappropriate surgical prophylaxis and discharge prescription

“…Moreover, considering the recent increase in antibiotic resistant pathogens on surgical wards [9], the importance of preventing the inappropriate use of SP becomes even more urgent. In a study we conducted in our own clinic, we found that our SP usage was highly inappropriate, and that these incorrect SP applications had even been continued onto the patients' discharge prescriptions [10]. For this reason, we decided to introduce an antibiotic stewardship program (ASP) to our clinic.…”

Assessment of prophylactic antibiotic usage habits of the general surgeons in Turkey

“…In literature evaluating how various surgical groups utilize SP, quite different rates of total compliance have been reported. For example, while total compliance to SP was less than 1% in Iran [14] and Korea [15], it was measured as 8-39.3% [4,10,11,16] in our country and 83.3% in South Africa, after introducing ASP [17]. A study by Hulscher et al, shows this variation in rates of antibiotic usage in hospitals to be influenced by many factors, such as cultural and contextual aspects, sociocultural and socioeconomic factors, organizational policies, attitudes and knowledge of the physician as well as the personality of both patients and doctors [2].…”

“…Local ethics committee approval was received for this study (21/13-2017). The questionnaire used for our survey was prepared together with infection control committee experts and general surgeons and firstly given to general surgeons in a tertiary education and research hospital [4]. Between May 2018 and April 2019, the questionnaire was distributed using a variety of methods: via e-mail, by hand, and posted on the web pages of various regional and national surgical associations.…”

“…Hence, in order to mitigate antibiotic resistance, one of the most important tasks of physicians, such as ourselves, must be to show the necessary duty of care for the correct use of antibiotics [2]. Unfortunately, the inappropriate use of antibiotics continues to be documented, both in our own country and abroad [3][4][5]. According to a study published in 2014, Turkey was reported to have the highest rate of antibiotic usage among 42 European Union (EU) and non-EU countries.…”

Preoperative Antibiotic Prophylaxis in Elective Minor Surgical Procedures among Adults in Southern Italy

“…Despite several studies focused on antibiotic prescribing habits in conjunction with surgeries in different countries having been recently published [ 16 , 17 , 18 ], little is known regarding the factors associated with SAP compliance in elective minor surgery [ 19 , 20 , 21 ]. Consequently, it is imperative to acquire such information.…”