Abstract
Surgical antimicrobial prophylaxis (SAP) is a common indication for antibiotic use in hospitals and is associated with high rates of inappropriateness. To describe the SAP prescribing practices and assess hospital, surgical, and patient factors associated with appropriate SAP prescribing. Multicenter, national, quality improvement study with retrospective analysis of data collected from Australian hospitals via Surgical National Antimicrobial Prescribing Survey audits from January 1, 2016, to June 30, 2018. Data were analyzed using multivariable logistic regression. Crude estimates of appropriateness were adjusted for factors included in the model by calculating estimated marginal means and presented as adjusted-appropriateness with 95% confidence intervals. Adjusted appropriateness and factors associated with inappropriate prescriptions. A total of 9351 surgical episodes and 15 395 prescriptions (10 740 procedural and 4655 postprocedural) were analyzed. Crude appropriateness of total prescriptions was 48.7% (7492 prescriptions). The adjusted appropriateness of each surgical procedure group was low for procedural SAP, ranging from 33.7% (95% CI, 26.3%-41.2%) for dentoalveolar surgery to 68.9% (95% CI, 63.2%-74.5%) for neurosurgery. The adjusted appropriateness of postprocedural prescriptions was also low, ranging from 21.5% (95% CI, 13.4%-29.7%) for breast surgery to 58.7% (95% CI, 47.9%-69.4%) for ophthalmological procedures. The most common reason for inappropriate procedural SAP was incorrect timing (44.9%), while duration greater than 24 hours was the most common reason for inappropriate postprocedural SAP (54.3%). High rates of inappropriate procedural and postprocedural antimicrobial use were demonstrated across all surgical specialties. Reasons for inappropriateness, such as timing and duration, varied according to the type of SAP and surgical specialty. These findings highlight the need for improvement in SAP prescribing and suggest potential targeted areas for action.
Highlights
Surgical antimicrobial prophylaxis (SAP) refers to the administration of antimicrobials for the prevention of surgical site infections (SSIs)
The adjusted appropriateness of each surgical procedure group was low for procedural SAP, ranging from 33.7% for dentoalveolar surgery to 68.9% for neurosurgery
High rates of inappropriate procedural and postprocedural antimicrobial use were demonstrated across all surgical specialties
Summary
Surgical antimicrobial prophylaxis (SAP) refers to the administration of antimicrobials for the prevention of surgical site infections (SSIs). International data consistently show 12% to 19% of inpatient antimicrobial prescriptions are for SAP.[1,2,3,4,5] Australian point prevalence data from the Hospital National Antimicrobial Prescribing Survey (Hospital NAPS)[4,5,6,7] found that 40.3% of surgical prophylaxis prescriptions were classified as inappropriate and 45.2% as noncompliant with Australian national Therapeutic Guidelines.[8,9] point prevalence methods do not capture the complexity of antimicrobial use in surgery, which should be assessed preoperatively and intraoperatively (or procedurally), and post procedurally.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
