When Antimicrobial Treatment and Surgical Prophylaxis Collide: A Stewardship Opportunity

Area of Science:

• Infectious Diseases
• Hospital Administration
• Pharmacology

Background:

• Established quality improvement projects like Surgical Infection Prevention (SIP) and Surgical Care Improvement Project (SCIP) aim to reduce surgical site infections (SSIs).
• These projects emphasize appropriate use of peri-operative prophylactic antibiotics, with guidelines from organizations like ASHP and IDSA.
• Hospitals report data to the Physicians Quality Reporting System for quality assessment and reimbursement, necessitating adherence to antibiotic protocols.

Purpose of the Study:

• To quantify the incidence of redundant pre-operative antibiotic use in surgical patients.
• To identify the risks associated with unnecessary antibiotic administration, including antimicrobial resistance and adverse events.
• To provide data supporting the enhancement of hospital antimicrobial stewardship programs.

Main Methods:

• A retrospective analysis of computerized hospital records was performed for November 2022.
• The study included patients who underwent surgical procedures and received pre-operative prophylactic antibiotics.
• Data focused on patients already receiving therapeutic antibiotics for the condition necessitating surgery.

Main Results:

• Out of 92 surgeries meeting inclusion criteria, 38 (41.3%) involved patients already on therapeutic antibiotics for over 24 hours.
• This redundancy was observed in procedures such as laparoscopic cholecystectomy, appendectomy, wound debridement, and soft tissue incision and drainage.
• Redundant antibiotic use comprised nearly 50% of these specific surgical procedures during the study period.

Conclusions:

• Significant opportunity exists to strengthen antimicrobial stewardship programs in hospitals.
• Physician education and empowering pharmacies to cancel unnecessary prophylactic antibiotics can reduce redundancy.
• Addressing antibiotic redundancy is crucial for combating antimicrobial resistance and improving patient safety.