[Pharmacoeconomic results of introducing antimicrobial prophylaxis in surgery at a university hospital]

The introduction of antimicrobial prophylaxis in surgery was designed and pre-intervention (controls) and post-intervention (cases) evaluations were carried out at a university tertiary hospital.

Prospective recording of information on prophylaxis in all patients undergoing non-emergency abdominal surgery was analysed during a 3-week period before and after implementing an antimicrobial prophylaxis program. Adequacy of prophylaxis was defined as prescription of antibiotics (type, dose and duration of treatment) according to the Guidelines.

In the pre-intervention study: included 36 patients; prophylaxis was inadequate in all patients (long-term in 22 cases; antibiotic class and long-term in 2 cases; antibiotic class, dose and long-term in 12 cases); mean duration of prophylaxis was 6 days (range 1 to 10 days); mean antibiotic cost per patient was 77 euro (range 9 to 412 euro); overall antibiotic cost for the 36 patients was 2770 euro. In the post-intervention study: included 37 patients: prophylaxis was inadequate in 11 patients (long-term in 10 cases; antibiotic class and long-term in 1 case); mean duration of prophylaxis was 2 days (range 1 to 9 days); mean antibiotic cost per patient was 16 euro (range 2 to 78 euro); overall antibiotic cost for the 37 patients was 593 euro. In the pre-intervention period antibiotic cost was 38 times higher than expected. In the post-intervention period it was 1.6 times higher than expected.

The most common reason of prophylaxis inadequacy is prolonged antibiotic treatment. A multidisciplinary intervention that comprises infectious diseases, surgical and pharmacy departments improves prophylaxis prescribing practice and avoids erroneous prescribing of antibiotics with both microbiological and economical cost savings.