Evaluation of prophylactic antibiotic administration at the surgical ward of a major referral hospital, Islamic Republic of Iran

Abstract

We evaluated the appropriateness of antibiotic prophylaxis administered before surgery at a major referral hospital in Shiraz, against the American Society of Hospital Pharmacists (ASHP) guidelines. Data on surgical procedure, choice of antibiotic and administration were gathered for all surgeries performed on hospitalized patients during 15 days in March 2010. Of 155 patients included in the analysis, 98% received prophylactic antibiotic before surgery; according to ASHP guidelines, prophylaxis was needed in only 106 (68.4%). Of these 106, only 8 patients received the correct antibiotic regimen. The commonest regimens administered were cefazolin + gentamicin (47.6%), cefazolin (20.5%) and cefuroxime (8.5%). Antibiotic prophylaxis was continued in 83% of cases, while this was necessary in only 37%. In only 1 surgical procedure were all evaluated parameters correct. ‫نيا‬ ‫فروغي‬ ‫فرزانه‬ ‫ناه،‬َ ‫رب‬ َ ‫داو‬ ‫عيل‬ ‫حممد‬ ‫نامزي،‬ ‫ها‬ ُ ‫س‬ ‫وصال،‬ ‫غزال‬ ‫مدينة‬ ‫يف‬ ‫الكربى‬ ‫اإلحالة‬ ‫مستشفيات‬ ‫أحد‬ ‫يف‬ ‫اجلراحة‬ ‫قبل‬ ‫احليوية‬ ‫للمضادات‬ ‫الوقائي‬ ‫اإلعطاء‬ ‫مة‬ َ ‫الء‬ ُ ‫م‬ ‫ملدى‬ ً ‫تقييام‬ ‫الباحثون‬ ‫أجرى‬ ‫قد‬ ‫اخلالصة:‬ ‫املضادات‬ ‫واختيار‬ ‫اجلراحية،‬ ‫اإلجراءات‬ ‫حول‬ ‫املعطيات‬ ‫ْع‬ َ ‫ج‬ ‫وتم‬ ‫املستشفيات.‬ ‫لصيادلة‬ ‫األمريكية‬ ‫للجمعية‬ ‫اإلرشادية‬ ‫للدالئل‬ ً ‫وفقا‬ ‫وذلك‬ ‫شرياز،‬ ‫وقد‬ .2010 ‫آذار/مارس‬ ‫شهر‬ ‫يف‬ ً ‫يوما‬ ‫عرش‬ ‫مخسة‬ ‫مدى‬ ‫عىل‬ ‫املستشفى‬ ‫يف‬ ‫ني‬ َ ‫عاجل‬ ُ ‫م‬ ‫مرىض‬ ‫عىل‬ ‫أجريت‬ ‫التي‬ ‫اجلراحات‬ ‫جيع‬ ‫من‬ ‫وإعطائها‬ ‫احليوية‬ ‫للجمعية‬ ‫اإلرشادية‬ ‫الدالئل‬ ‫عىل‬ ً ‫بناء‬ ‫بأنه‬ ً ‫علام‬ ‫اجلراحة؛‬ ‫قبل‬ ‫ّقائية‬ ‫ات‬ ‫حيوية‬ ‫مضادات‬ ‫َّوا‬ ‫تلق‬ ‫قد‬ ‫التحليل،‬ ‫يف‬ ‫درجوا‬ ُ ‫أ‬ ً ‫مريضا‬ 155 ‫أصل‬ ‫من‬ %98 ‫أن‬ َّ ‫تبني‬ ‫ثامنية‬ ‫تلقى‬ ‫مرىض،‬ 106 ‫الـ‬ ‫هؤالء‬ ‫بني‬ ‫ومن‬ .)%68.4( ‫حاالت‬ 106 ‫يف‬ ‫إال‬ ‫الوقاية‬ ‫هذه‬ ‫إىل‬ ‫حاجة‬ ‫هناك‬ ‫يكن‬ ‫مل‬ ‫املستشفيات،‬ ‫لصيادلة‬ ‫األمريكية‬ ‫ه‬ ‫وحدَ‬ ‫والسيفازولني‬ ،)%47.6( ‫اجلنتاميسني‬ ‫مع‬ ‫السيفازولني‬ ‫هو‬ ً ‫شيوعا‬ ‫العالجية‬ ‫النظم‬ ‫أكثر‬ ‫وكان‬ ‫احليوي.‬ ‫باملضاد‬ ‫الصحيح‬ ‫العالجي‬ ‫النظام‬ ‫فقط‬ ‫من‬ %37 ‫يف‬ ‫إال‬ ً ‫رضوريا‬ ‫ذلك‬ ‫يكن‬ ‫مل‬ ‫حني‬ ‫يف‬ ‫احلاالت،‬ ‫من‬ %83 ‫يف‬ ‫االتقائي‬ ‫احليوي‬ ‫املضاد‬ ‫إعطاء‬ ‫عىل‬ َ ‫وبر‬ ُ ‫ث‬ ‫وقد‬ .)%8.5( ‫والسيفيوروكسيم‬ ،)%20.5( ‫فقط.‬ ‫واحد‬ ‫جراحي‬ ‫إجراء‬ ‫يف‬ ‫صحيحة‬ ‫تقييمها‬ ‫جرى‬ ‫التي‬ ‫املتثابتات‬ ‫جيع‬ ‫وكانت‬ ‫فحسب.‬ ‫احلاالت‬ Évaluation de l'administration prophylactique d'antibiotiques au service de chirurgie d'un grand hôpital de recours en République islamique d'IranRÉSUMÉ Nous avons évalué l'opportunité de l'administration d'antibiotiques prophylactiques avant une intervention chirurgicale dans un grand hôpital de recours à Chiraz, conformément aux directives de l'American Society of Health-System Pharmacists [Société américaine des pharmaciens du système de soins de santé]. Les données sur l'acte chirurgical, le choix des antibiotiques et leur administration ont été collectées pour toutes les interventions chirurgicales réalisées chez des patients hospitalisés pendant 15 jours en mars 2010. Sur 155 patients, 98 % d'entre eux ont reçu une ant...

Evaluation of antibiotic prophylaxis administration at the orthopedic surgery clinic of tertiary hospital in Jakarta, Indonesia

“…Regarding the choice of antibiotics and sensitivity patterns of bacteria in local hospital, we found that only 6.1% of the antibiotic prophylaxis prescription was in accordance with the guidelines for prophylactic antibiotics. This result was comparable with the other study conducted in Iran that the appropriateness of choosing antibiotic prophylaxis for general surgery was about 7.5% [6] . Another previous study reported that the appropriateness of the selection of antibiotic prophylaxis in 3 hospitals (a government hospital, a medical college teaching hospital, and a corporate hospital) in Mangalore, India were 14.1%, 23.3% and 32.9% respectively [24] .…”

“…Appropriate prophylactic antibiotics administration before surgery can reduce the incidence of SSI. However, inappropriateness of antibiotic prophylaxis administration is still commonly found in various surgical procedures, including orthopedic surgery [3][4][5][6] .…”

“…However, adherence to the guidelines in choosing the type and timing of antibiotic prophylaxis administration is not always followed [1,5,6,[10][11][12][13] . This situation has led to high incidence of antibiotic resistance worldwide, which has a significant impact on public health issues, especially on treatment outcomes.…”

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

“…Studies conducted in Asian countries have generally reported higher prevalence of inappropriate antibiotic use for prophylaxis (48-100%) when compared to developed countries (23.4%-55.2%) [15,16,17,18,19]. Inappropriate timing of antibiotic administration (36.4%) and inappropriate duration (34.5%) were found to be the main reasons for inappropriate prophylactic antibiotic which was also similar to previous studies [17,18,20].…”

Utilization Assessment of Surgical Antibiotic Prophylaxis at Ayder Referral Hospital, Northern Ethiopia

“…Furthermore, studies from different countries have found that SAP was used excessively and inappropriately [8][9][10][11][12][13][14][15][16][17][18][19]. A wide variation of overall compliance was seen that range from 0 to 71.9% in various surgical procedures, majority of these studies revealed that noncompliance were in terms of selection, timing of administration and prolonged duration of SAP; indication and dose of SAP were more satisfactory compliant than other parameters [20].…”