Abstract
BackgroundThe appropriate use of antibiotics prophylaxis in the prevention and reduction in the incidence of surgical site infection is widespread. This study evaluates the appropriateness of the prescription of antibiotics prophylaxis prior to surgery amongst hospitalized patients in the geographic area of Avellino, Caserta, and Naples (Italy) and the factors associated with a poor adherence.MethodsA sample of 382 patients admitted to 23 surgical wards and undergoing surgery in five hospitals were randomly selected.ResultsPerioperative antibiotic prophylaxis was appropriate in 18.1% of cases. The multivariate logistic regression analysis showed that patients with hypoalbuminemia, with a clinical infection, with a wound clean were more likely to receive an appropriate antibiotic prophylaxis. Compared with patients with an American Society of Anesthesiologists (ASA) score ≥4, those with a score of 2 were correlated with a 64% reduction in the odds of having an appropriate prophylaxis. The appropriateness of the timing of prophylactic antibiotic administration was observed in 53.4% of the procedures. Multivariate logistic regression model showed that such appropriateness was more frequent in older patients, in those admitted in general surgery wards, in those not having been underwent an endoscopic surgery, in those with a higher length of surgery, and in patients with ASA score 1 when a score ≥4 was chosen as the reference category. The most common antibiotics used inappropriately were ceftazidime, sultamicillin, levofloxacin, and teicoplanin.ConclusionsEducational interventions are needed to improve perioperative appropriate antibiotic prophylaxis.
Highlights
Health care-associated infections (HCAIs) are an important public health threat that concerns the safety of patients and health care professionals since they are one of the leading causes of morbidity and mortality in industrialized and developing geographical region
The distribution of HCAIs according to the site of infection indicated that the Surgical Site Infections (SSIs) are the most frequent among patients undergoing surgical procedures and they are considered an important indicator of the quality of the health care
More than half was female, the average age was 54.2 years (14–94), half of the sample had been admitted in general surgical wards, 16.6% were diabetics, 15.1% showed low serum albumin, only 7.7% had a clinical infection on admission, and 16.1% had a American Society of Anesthesiologists (ASA) score 4/5
Summary
Health care-associated infections (HCAIs) are an important public health threat that concerns the safety of patients and health care professionals since they are one of the leading causes of morbidity and mortality in industrialized and developing geographical region. The importance of the prevention and control of SSIs has been well recognized and the effectiveness of interventions has been extensively studied and many of them have been demonstrated as being effective, including surveillance systems, preoperative preparation for the patient, appropriate administration of antibiotics prophylaxis before the initiation of surgery, aseptic procedures in the operating theatre, careful and skilled surgical technique, and postoperative surgical site or wound care. The use of antibiotics prophylaxis in the prevention and reduction in the incidence of SSIs is widespread and evidences have demonstrated the importance of timing of administration, selection of the agent, and duration of the prophylaxis [1]. This study evaluates the appropriateness of the prescription of antibiotics prophylaxis prior to surgery amongst hospitalized patients in the geographic area of Avellino, Caserta, and Naples (Italy) and the factors associated with a poor adherence
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