Category: Professional Posters
Purpose: Surgical-site infection is a major cause of nosocomial infections, and the appropriate selection of surgical prophylactic antibiotics can reduce surgical-site infection, drug adverse reaction, antimicrobial resistance development, and cost. Antimicrobial stewardship programs promote the appropriate use of antimicrobials.
Our antimicrobial stewardship program team developed “The guidelines for antimicrobial prophylaxis in surgery ” in 2014 and revised it in 2018.
We aimed to evaluate changes in the rate of appropriate antibiotic use by implementing the guidelines as part of the antimicrobial stewardship program.
Methods: Our multidisciplinary team, consisting of an infectious disease specialist and pharmacists, that executes antimicrobial stewardship programs selected the surgeries to be included in the guidelines, explored evidence through literature review, developed the guidelines, and obtained feedbacks from the prescribing departments.
We evaluated the use of prophylactic antibiotics for surgery based on the new guidelines and recommended to change inappropriate antibiotic use. New clinical pathways were reviewed based on the guidelines. The guidelines were disseminated via databases and booklets.
The guidelines were revised by adding the following surgeries via the same process: hernia repair and clean-contaminated head and neck surgery.
The rate of appropriate use and change in prophylactic antibiotic use for surgery at 6 months before and after the development (in 2014) and revision (in 2018) of guidelines were evaluated.
Results: Fifteen surgeries (clean/clean-contaminated procedure) were initially included in the guidelines, and two surgeries were added later.
The appropriate use rate of surgical prophylactic antibiotics was 1.6%–100% (mean ± SD = 77.2 ± 31.8%) before the development of guidelines and 79.7%–100% (93.8 ± 7.0%) after the development, with a mean increase of 16.5%.
The mean appropriate antibiotic use rate after the revision was 92.6% (62.6%–100%, SD = 11.2%), a drop by 1.1% (p≥ 0.05 ) from that before the revision.
The antibiotic use rate for the newly included surgeries, namely hernia repair and clean-contaminated head and neck surgery was 0.6% and 28.4%, but increased to 81.4% and 65.9% after the revision, respectively.
Conclusion: The strategy of developing institutional guidelines, collecting feedback from prescribers, reporting to the committee and recommending changes can promote the appropriate use of antimicrobial prophylactic antibiotics for surgery, which can reduce antimicrobial resistance and enhance safety.