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Utilization of neurosurgical perioperative antimicrobial prophylaxis in a Chinese teaching hospital
Weiwei Zhang1, Huijie Meng2, Chientai Mao2
1Department of Clinical Pharmacy, Beijing Tsinghua ChangGung Hospital, School of Medicine, Tsinghua University, Beijing, China. zwwa00410@btch.edu.cn.
Insights
Neurosurgical antimicrobial prophylaxis in China shows significant practice gaps, with prolonged durations and missed re-dosing. Adhering to guidelines could halve antimicrobial use and costs, highlighting the need for stewardship.
Area of Science:
- Medical Microbiology
- Surgical Prophylaxis
- Health Economics
Background:
- Antimicrobial prophylaxis audits identify prescribing gaps in healthcare.
- Limited data exists on neurosurgical perioperative antimicrobial prophylaxis costs, quality, and use in China.
Purpose of the Study:
- To assess the appropriateness of perioperative antimicrobial prophylaxis in neurosurgery.
- To analyze the associated costs, quality, and antimicrobial use density.
Main Methods:
- Retrospective study of 262 neurosurgical patients without infections in 2017.
- Evaluation of prophylaxis appropriateness against international and Chinese guidelines.
- Analysis of discrepancies in indication, choice, dose, route, timing, re-dosing, and duration.
Main Results:
- 82.8% of procedures had inappropriately prolonged prophylaxis duration.
- 32.1% of procedures missed intraoperative re-dosing.
- Antimicrobial choice (95%) and timing (100%) were generally appropriate.
- Guideline adherence could reduce defined daily doses by 46.9% and costs by 75.5% ($2000 to $490).
Conclusions:
- Significant discrepancies exist in current neurosurgical perioperative antimicrobial prophylaxis practices.
- Improved antimicrobial stewardship is crucial for optimizing prophylaxis in China.
- Implementing guidelines can lead to substantial reductions in antimicrobial use and healthcare costs.
Abstract:
Background Audits of antimicrobial prophylaxis is an essential strategy to identify practice gaps in antimicrobial prescribing in healthcare facilities. There is a lack of studies on the costs, quality, and antimicrobial use density of neurosurgical perioperative antimicrobial prophylaxis in China. Objectives Evaluate the appropriateness of perioperative antimicrobial prophylaxis in neurosurgeries and analyze the costs, quality, and antimicrobial use density of neurosurgical perioperative antimicrobial prophylaxis. Setting Beijing Tsinghua Changgung Hospital, a teaching hospital in Beijing. Methods This retrospective study was conducted among 262 neurosurgical patients without infections during 2017. The appropriateness of perioperative antimicrobial prophylaxis was determined based on relevant international and Chinese perioperative antimicrobial prophylaxis guidelines. Main outcome measures Discrepancy rates in perioperative antimicrobial prophylaxis, including indication, choice of antimicrobials, dose, route of administration, time of administration of the first dose, re-dosing, and duration, were analyzed. Results Discrepancies were observed between current practice and relevant guidelines. A total of 51 (32.1%) procedures failed to administer intraoperative re-dosing as needed, and the perioperative antimicrobial prophylaxis duration of 217 (82.8%) procedures was inappropriately prolonged. The choice of antimicrobial agents was optimal in 249 (95%) procedures, and the timing of perioperative antimicrobial prophylaxis was appropriate in all procedures. If perioperative antimicrobial prophylaxis was implemented according to guidelines, the defined daily dose per 100 procedures would decrease from 31.97 to 16.99, and the total cost would reduce from $2000 to $490. Conclusions Effective antimicrobial stewardship is urgently needed to promote the appropriateness of neurosurgical perioperative antimicrobial prophylaxis in China.
