Antibiotic Use in Surgical Wards: A Point Prevalence Survey Based on the WHO AWaRe Methodology

Area of Science:

• Pharmacology
• Infectious Diseases
• Public Health

Background:

• Current surgical antibiotic prophylaxis (SAP) reporting often lacks integration with World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classes and standardized volume metrics.
• Evaluating antibiotic utilization requires comprehensive data, including prescription numbers and defined daily doses (DDDs).

Purpose of the Study:

• To assess SAP antibiotic utilization in an Italian teaching hospital using both prescription counts and DDDs.
• To map WHO AWaRe classes across surgical specialties to identify management-specific differences.

Main Methods:

• Prospective hospital-wide surveillance of SAP in surgical patients from March to May 2023.
• Classification of SAP prescriptions using the 2023 WHO AWaRe framework.
• Quantification of antibiotic consumption via WHO ATC/DDD methodology.

Main Results:

• Of 793 patients with complete data, 433 SAP prescriptions were analyzed.
• Cefazolin was the most frequent agent (82%).
• 93% of SAP prescriptions and 87.8% of DDDs were WHO Access agents; 7% of prescriptions and 12.2% of DDDs were Watch agents; no Reserve agents were used.

Conclusions:

• Combining AWaRe classes with DDDs and specialty-specific data provides a robust framework for SAP benchmarking.
• The high proportion of Access agents aligns with antimicrobial stewardship objectives.
• Inter-specialty variations highlight opportunities for targeted quality improvement initiatives in SAP.