Abstract
Clean surgery without contamination does not require prophylactic antibiotics, but there are high-risk surgical procedures that may cause infection and/or involve vital organs such as the heart, brain, and lungs, and these indeed require the use of antibiotics. This study aimed to determine the quantity of antibiotic use based on the defined daily dose (DDD) per 100 bed days and the quality of antibiotic use based on the percentage of concordance with The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines (i.e., route of administration, time of administration, selection, dose, and duration). This includes the profiles of surgical site infection (SSI) in surgical patients from January through June 2019. The study subjects were 487 surgical patients from two hospitals who met the inclusion criteria. There were 322 patients out of 487 patients who had a clean surgical procedure. Ceftriaxone (J01DD04) was the most used antibiotic, with a total DDD/100 bed days value in hospitals A and B, respectively: pre-surgery: 14.71, 77.65, during surgery: 22.57, 87.31, and postsurgery: 38.34, 93.65. In addition, 35% of antibiotics were given more than 120 min before incision. The lowest concordance to ASHP therapeutic guideline in hospital A (17.6%) and B (1.9%) was antibiotic selection. Two patients experienced SSI with bacterial growths of Proteus spp., Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. The usage of prophylactic antibiotics for surgical procedures was high and varied between hospitals. Hospital B had significantly lower concordance to antibiotic therapeutic guidelines, resulting to a higher infection rate, compared with hospital A. ASHP adherence components were then further investigated, after which antibiotic dosing interval and injection time was found to be a significant predictor for positive bacterial growth based on logit–logistic regression. Further interventions and strategies to implement antibiotic stewardship is needed to improve antibiotic prescriptions and their use.
Highlights
Antimicrobial resistance threatens global health; antibiotic use in surgical specialties is an infection control indicator and may reflect the incidence of surgical site infection
defined daily dose (DDD) is defined as the use of antibiotics based on the average daily dose given to 70 kgs adult patients according to main therapeutic indications
The results in this study indicated that of the 487 samples analyzed between January and June 2019, the percentage of compliance with American Society of Health-System Pharmacists (ASHP) therapeutic guidelines for the selection of antibiotic types was 18% in hospital A and 2% in hospital B
Summary
Antimicrobial resistance threatens global health; antibiotic use in surgical specialties is an infection control indicator and may reflect the incidence of surgical site infection. Indonesia, antibiotics are given before the incision and during the time from admission to discharge from the hospital which may result in higher chances of antimicrobial resistance. A new strategy is needed to overcome this problem. Surgery is a medical procedure in the form of an incision made by a surgeon with the aim of preventing or treating an illness. All surgical procedures can pose a risk of infection. Antibiotic prophylaxis is needed to prevent postoperative infection
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