Category: Professional Posters
Purpose: Surgical site infection is one of the leading causes of healthcare associated infections. As per the ASHP guidelines, it is recommended to administer the proper type of antimicrobial based on surgical site and risk factors. It was noted that surgeons are not compliant to guidelines.
This retrospective analysis is designed to evaluate the impact of clinical pharmacy intervention and education on prescribing pattern of antimicrobial prescription for urological surgeries
Methods: Clinical pharmacists at Al Wakra Hospital initiated a quality project to improve antimicrobial prophylaxis in surgical department. International guidelines and primary articles were reviewed which influenced national Hamad Medical Corporation guidelines. Data was collected retrospectively including patients who underwent elective or emergent urological surgery from 1st November 2017 to 1st of December 2017. Demographics, previous culture, antibiotic prophylaxis, and antibiotics at discharge data were obtained. This data was then compared to previous medication use evaluation conducted in 2016.
Results: A total of 72 patients were included. The average patient's age was 42 years, and of these 86.1% were male. A total of 58.91%, 8.22% and 32.87% underwent ureteroscopy, cystoscopy, and other urological surgeries, respectively. Urine culture was done in 55 patients. Antibiotic prophylaxis was appropriate in 69 patients (95.8%). Antibiotics used were mainly cefuroxime for ureteroscopy, cefazolin or amoxicillin/clavulanate for penile repair, and ertapenem for biopsy. All patients scheduled for prosthesis received vancomycin plus gentamicin which is appropriate. This was compared to a low compliance rate in 2016 (17% compliant). However, many patients were still discharged on antimicrobials when not required. Physicians were educated about this and are in process of changing their practice.
Conclusion: Clinical pharmacists positively impacted Antimicrobial prescribing in urology surgeries. The overall, antimicrobial prescribing pattern for urological surgeries is appropriate. However, antibiotics prescribed at discharge were mostly inappropriate. Plan to improve antibiotic use at discharge is to stop prescribing antimicrobials for patients with no growth in culture, and those who require only skin incision prophylaxis