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Antimicrobial prophylaxis in surgery in Belgian hospitals: room for improvement
X Kurz1, R Mertens, O Ronveaux
1Institute of Hygiene and Epidemiology, Epidemiology Section, Brussels, Belgium.
Objective:
To evaluate the current practice of surgical antimicrobial prophylaxis in Belgium.
Design:
Prospective multicentre incidence study.
Setting:
58 of the 206 acute hospitals in Belgium.
Subjects:
19746 patients who had operations between October 1992 and June 1993, with detailed analysis of 7983 procedures for which the antimicrobial regimens were known.
Results:
Antibiotic prophylaxis was given before 14099 (71%) of the 19746 operations. It was given in 57% of the procedures for which prophylaxis is generally not recommended, but it was not used in 14% of procedures for which it is generally recommended, nor in 14% of all contaminated procedures. Duration of operation superseded degree of wound contamination, ASA (American Society of Anesthesiologists) score, and degree of urgency as a predictor of the use of prophylaxis. Prophylaxis was prolonged by more than 2 days postoperatively after 23% of the procedures and by more than 4 days in 8%. Five types of regimens accounted for 80% of all prophylaxis, but overall 234 different regimens were prescribed. Large differences were found in hospital university affiliation status. In general, trends were favourable compared with a study in 1986.
Conclusion:
Although there was improvement compared with 1986, antimicrobial prophylaxis in surgery could still be more appropriate in terms of indication, duration, and rational choice of drugs.