Quality of perioperative antibiotic administration by French anaesthetists

Antibiotics are the most prescribed drugs in hospitals in France and approximately one-third of prescriptions are for antimicrobial prophylaxis. Although the principles of prophylaxis have been defined over the years, there is still widespread misuse of antimicrobials for that purpose. The aim of this survey was to determine whether prescription of prophylactic antibiotics by French anaesthetists complies with the French Guidelines on Surgical Antibiotic Prophylaxis. Information was sought concerning the agent(s) recommended, the timing of the first dose and the duration of prescription. A total of 1473 French anaesthetists was studied. For the great majority (93%), the first antibiotic dose is administered at time of induction of anaesthesia, as recommended by the guidelines. First- and second-generation cephalosporins are frequently selected, as well as co-amoxiclav. In contrast to the guidelines, third-generation cephalosporins (3GCs) are widely prescribed in digestive and urological surgery and quinolones in urological surgery. Duration of prescription is limited to 48 h by most anaesthetists (94%), however there is a strong tendency to prescribe prophylaxis for longer periods in the immunocompromised and patients undergoing major surgery. This survey indicates discrepancies between the French Guidelines on Surgical Antibiotic Prophylaxis and the current practice of French anaesthetists. Major concerns are the use of antibiotics such as 3GCs or fluoroquinolones and prescription for periods exceeding 48 h. In conclusion, compliance with guidelines for prophylactic antimicrobial administration should be more strict in surgical patients.