Post-surgical antibiotic prophylaxis: Impact of pharmacist’s educational intervention on appropriate use of antibiotics

Butt, Saba Zia; Ahmad, Muhammad Ijaz; Saeed, Hamid; Saleem, Zikria; Javaid, Zaida

doi:10.1016/j.jiph.2019.05.015

Cited by 42 publications

(66 citation statements)

References 26 publications

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“…Similar to our findings, a study from Pakistan reported that the most frequent gram-negative isolate was P. aeruginosa (32.2%) followed by Klebsiella (16.5%) and E. coli (12.5%), while imipenem, meropenem and tazobactam were among the most effective antibiotics [40]. These data suggested that the irrational or misuse of antibiotics due to self-prescribing upon experiencing similar symptoms, non-adherence to standard treatment guidelines [19], [20], poor knowledge of clinician and the patient, and limited finances, could contribute to antimicrobial resistance towards the majority of first line and even the second line therapeutic options in various gram-negative URTP.…”

Section: Discussionsupporting

confidence: 88%

“…However, most of the isolates were susceptible to erythromycin, cefaclor, cephalothin, ceftriaxone, cefuroxime, rifampicin, vancomycin, and clindamycin [17]. Unfortunately, in Pakistan, it is very difficult to implement nationwide standard antibiotic prescribing guidelines because of multiple factors, such as doctor's default believes about the use of antibiotics, availability of selected medicines as per the doctor's wish, unethical practices by doctor, drug retailer and manufacturer, poor regulatory practices and non-availability of un-hygienic conditions [18], [19], [20].…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic susceptibility Patterns against Upper Respiratory Tract Pathogens in Tertiary Care Hospitals of Lahore, Pakistan

Ullah

Baloch

Iqbal

et al. 2019

Preprint

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Backgrounds In Pakistan, despite the surge in antibiotic consumption scanty of literature evidences exist regarding antibiotic susceptibility patterns in URTIs. Thus, we conducted the study to evaluate the antibiotic susceptibility patterns in URTIs.Methods A cross-sectional study was conducted by collecting 259 culture samples from tertiary care hospitals of Lahore, Pakistan. Using simple random sampling, culture reports of even numbered patient were included as per study inclusion criteria.Results Two hundred sixty samples were processed out of which only 144 (55.4%) samples yielded growth, i-e., 42.7% males and 49% females. In males, the resistance was high against ceftazidime (19.3%), ampicillin (13.1%), ciprofloxacin (11.6%) and gentamicin (10.8%), while in female samples it was significant against cefuroxime (6.9%), ampicillin (5.4%), tobramycin (4.6%) and ciprofloxacin (6.5%). Besides, males were sensitive against imepenem (25.8%), amikacin (22%), ceftazidime (19.3%), ciprofloxacin (19.3%) and piptaz (16.2%), while females were sensitive against amikacin (9.2%), imepenem (9.2%) and ciprofloxacin (6.9%). Overall, carbepenems, imipenem (35%) and meropenem (30.8%), were found highly sensitive followed by aminoglycosides (amikacin; 31.9%), quinolones (ciprofloxacin; 26.3%), piptaz (19.2%) among penicillin and cephalosporin, while resistant was maximum against cephalosporin (ceftazidime; 25.4%) followed by penicillin (ampicillin, 18.5%) and quinolones.Conclusion These data suggested that P. aeruginosa and Klebsiella , were the most frequent bacterial isolates in URTIs of Lahore, Pakistan. These isolates were resistant to ampicillin, cefuroxime and ceftazidime, but were sensitive to carbapenem and aminoglycoside class of antibiotics. Thus, health care professionals, policy makers and drug regulators must devise policies to overcome the menace of growing antimicrobial resistance.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Antibiotic susceptibility Patterns against Upper Respiratory Tract Pathogens in Tertiary Care Hospitals of Lahore, Pakistan

Ullah

Baloch

Iqbal

et al. 2019

Preprint

Self Cite

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“…A study conducted in Pakistan revealed that 13% of the patients who underwent elective surgery had encountered with SSIs [6]. Another recent study reported that the rate of SSIs was 6.5% in patients who underwent elective surgeries [7].…”

Section: Introductionmentioning

confidence: 99%

“…Inappropriate use of PAP, a high prevalence of multi-drug resistance, unavailability of local standard guidelines and limited available research on the utilization of PAP in Pakistani hospitals are still the main problems [6,7,[21][22][23]. Based on the aforementioned explanation, we constructed a research hypothesis that limited PAP statistics, inappropriate prescription of PAP and unavailability of guidelines would lead to poor adherence with the standard treatment guidelines.…”

Section: Introductionmentioning

confidence: 99%

Audit of pre-operative antibiotic prophylaxis usage in elective surgical procedures in two teaching hospitals, Islamabad, Pakistan: An observational cross-sectional study

et al. 2020

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An audit of the antibiotic prophylaxis in surgical procedures is the basic area of antimicrobial stewardship programme. The current research aimed to evaluate the adherence-proportion of the pre-operative antibiotic prophylaxis (PAP) practices in common elective surgical procedures. It was an eight-month (January 2017 to August 2017) observational cross-sectional patients' treatment record-based study conducted at two tertiary care teaching hospitals of Islamabad, Pakistan. We investigated the three most commonly performed elective general surgical procedures at the hospitals in adults aged > 18 years with no previous infection or surgery. The required data were extracted from the medical charts. Current prescribing practices were compared with the standard prescribing guidelines. A total of 660 (Government Hospital (GH), n = 330 and Private Hospital (PH), n = 330) procedures were observed. The most commonly performed elective general surgical procedures were laparoscopic cholecystectomy 307/660 (46.5%), followed by direct inguinal hernia 197/660 (29.8%) and total thyroidectomy 156/660 (23.6%). Non-use of PAP was observed in 64/660 (9.7%) cases. PAP was given to 90.3% (n = 596/660) cases (300/330 (90.9%) patients in GH and 296/330 (89.7%) in PH; P = 0.599). Based on the existing guidelines, the choice of antibiotics was correct in only 4.2% (25/596) patients (10/300; 3.3% cases at GH and 15/ 296; 5% at PH). The appropriate use of antibiotics was significantly greater in direct inguinal hernia (n = 19/193; 9.8%) cases compared with that in total thyroidectomy (n = 4/152; 2.6%) and laparoscopic cholecystectomy (n = 2/251; 0.8%) cases; P = 0.001. Compliance to the timing was only 51% (n = 304/596) of the total patients received PAP which was significantly lower in GH 97/300 (32.3%) as compared with that in PH 207/296 (69.9%); P = 0.001. Administration timing of antibiotics was observed to be more appropriate in total thyroidectomy (n = 79/152; 51.9%) cases than in laparoscopic cholecystectomy (n = 130/251; 51.8%) and direct inguinal hernia (n = 95/193; 49.2%) cases; P = 0.001. The route and dose were appropriate in accordance with the guidelines in all cases (100%). Most of the patients

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“…The participation of the pharmacist within the health care team translates into a decrease in unnecessary costs, an increase in the quality of care and an improvement in the patient's quality of life. These results have led to the acceptance of this professional by other members of the health team[38][39][40][41][42][43]. To date, there is no clinical pharmacist at the target institution involved in the design, implementation and review of therapeutic protocols, including PAP.…”

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confidence: 99%

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

Viamonte

Tames²,

Correa

et al. 2020

Preprint

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Background Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. Methods A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. Results The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR=2.79, P=0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR=1.33, P=0.649). Also, a significant relationship was found between SSI and patient age (Chisq=8.08, P=0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. Conclusions Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

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Post-surgical antibiotic prophylaxis: Impact of pharmacist’s educational intervention on appropriate use of antibiotics

Cited by 42 publications

References 26 publications

Antibiotic susceptibility Patterns against Upper Respiratory Tract Pathogens in Tertiary Care Hospitals of Lahore, Pakistan

Antibiotic susceptibility Patterns against Upper Respiratory Tract Pathogens in Tertiary Care Hospitals of Lahore, Pakistan

Audit of pre-operative antibiotic prophylaxis usage in elective surgical procedures in two teaching hospitals, Islamabad, Pakistan: An observational cross-sectional study

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

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