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[Antibiotic prophylaxis and surgery. Prescription compliance in Franche-Comté with the national reference system]
1Service d'hygiène hospitalière, CHU Jean-Minjoz, 25030 Besançon, France.
Insights
Surgical antibiotic prophylaxis adherence was low, with only 40% conformity to national guidelines in France. This study highlights the need for regular audits to ensure effective prophylaxis and prevent antibiotic resistance.
Area of Science:
- Medical Microbiology
- Surgical Practices
- Infectious Disease Epidemiology
Context:
- Antibiotic prophylaxis is crucial in preventing surgical site infections.
- Adherence to established guidelines ensures optimal patient outcomes and combats antimicrobial resistance.
- Practices in the Franche-Comté region of France were evaluated against national recommendations.
Purpose:
- To assess the adherence of surgical teams to national guidelines for antibiotic prophylaxis.
- To identify deviations in antibiotic selection, timing, duration, and dosage.
- To provide data for improving surgical prophylaxis practices.
Summary:
- A prospective surveillance study analyzed 513 surgeries, finding only 40% conformity with Société Française d'Anesthésie et Réanimation (SFAR) recommendations.
- Deviations included using broader-spectrum antibiotics (85.5%) and extended prophylaxis duration (87.9% of non-compliant cases).
- Less than 50% of patients received guideline-adherent antibiotic prophylaxis.
Impact:
- Findings underscore a significant gap between recommended and actual practices in surgical antibiotic prophylaxis.
- Non-adherence risks reduced prophylaxis efficacy and contributes to the emergence of antibiotic-resistant bacteria.
- Regular audits by infection control teams are recommended to improve compliance and patient safety.
Aim Of The Study:
To evaluate the practice of antibiotic prophylaxis for surgery in the Franche-Comté region of France.
Materials And Methods:
A total of 36 surgical teams (72 pairs surgeons/anaesthesists) participated in data collection. Five variables describing practices concerning antibiotic prophylaxis for surgery were compared to national recommendations: did the surgical procedure require antibiotic prophylaxis and was it carried out? Was the antibiotic used appropriately? Was the timing of the first injection optimal? Was the total duration of the treatment correct? Was the dose correct?
Results:
Among the 687 operations for which data were collected, 513 (74.7%) that corresponded to class 1 or 2 Altemeier operations for which the Société Française d'Anesthésie et Réanimation (SFAR) had drawn up recommendations were analysed in order to answer these questions. The overall frequency of conformity with the regulations was 40% for these 513 operations. Of the 156 patients who did not receive the recommended antibiotic, 133 (85.5%) received an antibiotic with an activity range wider than that of the recommended antibiotic. The duration of prophylaxis was longer than recommended in 80 (87.9%) out of the 91 patients for whom the duration of antibiotic prophylaxis did not respect the recommendations.
Conclusions:
This prospective surveillance showed that less than 50% of patients received an antibiotic prophylaxis that was conformed to the regulations. To ensure the efficiency of prophylaxis and to prevent deleterious effects, such as the emergence of antibiotic-resistant bacteria, the recommendations must be regularly respected. Frequent audits of practices should be carried out by the teams responsible for fighting nosocomial infections.