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Prospective study of use of perioperative antimicrobial therapy in general surgery
Brendan G Fennessy1, Martin J O'Sullivan, Greg J Fulton
1Department of Surgery, Cork University Hospital, Cork, Ireland.
Background:
Perioperative antimicrobial therapy has demonstrated efficacy in reducing the rate of surgical site infections in clinical trials. With the emergence of antibiotic resistance, the risk of reaction, and the inevitable financial repercussions, use of prophylactic antibiotics is not a panacea, and their misuse may have considerable implications. The aim of this study was to assess the use of antibiotics in the perioperative period in both general and vascular surgery procedures.
Methods:
A prospective study was undertaken of 131 patients with a mean age of 43 years (range one month-88 years), of whom 68 (51%) were male, who underwent twenty-seven different general or vascular surgery procedures over a four-week period. Each patient was evaluated from the time of antibiotic commencement through their operative procedure until the treatment was discontinued.
Results:
A total of 73 patients (54%) received ten antibiotics, with 71 (97%) of these uses being prophylactic. Of the 15 appendectomies performed for uncomplicated appendicitis, the mean number of prophylactic antibiotic doses was 5.3 (range 1-12). Where they were documented, written postoperative directives were not adhered to in 18/27 prescriptions (66%).
Conclusion:
This study has demonstrated a lack of adherence to guidelines in the perioperative administration of antimicrobial agents. In addition, it calls attention to the economic implications of unnecessary prophylaxis.
Insights
This study reveals significant non-adherence to antimicrobial guidelines in perioperative care, highlighting the economic impact of unnecessary antibiotic prophylaxis. Improving antibiotic stewardship is crucial for patient safety and resource management.
Area of Science:
- Surgical Infection Prevention
- Antimicrobial Stewardship
- Health Economics
Background:
- Perioperative antimicrobial therapy is effective but faces challenges from antibiotic resistance, adverse reactions, and cost.
- Misuse of prophylactic antibiotics can have significant negative implications.
Purpose of the Study:
- To evaluate the current practices of antibiotic use during the perioperative period in general and vascular surgery.
- To identify deviations from established guidelines in antimicrobial administration.
Main Methods:
- A prospective study involving 131 patients undergoing various general or vascular surgery procedures over four weeks.
- Patient antibiotic use was tracked from initiation through discontinuation post-operation.
Main Results:
- 54% of patients received antibiotics, with 97% of these being prophylactic.
- For uncomplicated appendectomies, the average number of prophylactic doses was 5.3.
- Postoperative directives were not followed in 66% of documented prescriptions.
Conclusions:
- There is a notable lack of adherence to guidelines for perioperative antimicrobial administration.
- The study underscores the economic burden associated with unnecessary prophylactic antibiotic use.
