Survey and evaluation of antibiotic prophylaxis usage in surgery wards of tertiary level institution before and after the implementation of clinical guidelines

S. Khan, P. Rao, A. Rao, G. Rodrigues

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8 Citations (Scopus)

Abstract

Background: Wound infections are the commonest hospital-acquired infections in surgical patients. Approximately 30-50% of antibiotic use in hospitals, is now for surgical prophylaxis. However, between 30-90% of this prophylaxis is inappropriate, that increases the selective pressure favoring the emergence of antimicrobial resistance. Judicious use of antibiotics in the hospital through effective antibiotic policy and guideline development is thus essential. Aims: To prepare a guideline for surgical antibiotic prophylaxis and to evaluate the impact of it in clinical practice. Settings and Design: A retrospective and prospective study was carried out over a nine month period, in a surgical unit of a tertiary care institution. Materials and Methods: An antibiogram was prepared to evaluate the sensitivity pattern retrospectively. A prospective study was done to evaluate the prescription pattern of antibiotic prophylaxis and incidence of surgical site infection. A draft guideline was prepared with expertise by the surgeon. Standardized recommendations in the guideline were done by the nominal group technique. Post-recommendation evaluation was done to observe the impact of the guideline in clinical practice. Results and Conclusions: 222 cases were evaluated during the pre-recommendation period, of which 21 were infected with surgical site infections that were rated as 9.45%. Use of prophylactic antibiotics was widespread and inconsistent with published guidelines. 56 cases were evaluated during the post-recommendation period. None of the cases were infected. Prophylactic antibiotic use was consistent with respect to choice and duration. The study showed the importance of a multidisciplinary approach in implementing local guidelines in healthcare institutions, as per their hospital antimicrobial sensitivity pattern and expert′s opinions.
Original languageEnglish
Pages (from-to)150-156
Number of pages7
JournalIndian Journal of Surgery
Volume68
Issue number3
Publication statusPublished - 2006

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Antibiotic Prophylaxis
Guidelines
Anti-Bacterial Agents
Surgical Wound Infection
Prospective Studies
Policy Making
Expert Testimony
Microbial Sensitivity Tests
Wound Infection
Tertiary Healthcare
Cross Infection
Surveys and Questionnaires
Prescriptions
Retrospective Studies
Delivery of Health Care
Incidence

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@article{b2a8a8faaca04aaeb947b14215e53e52,
title = "Survey and evaluation of antibiotic prophylaxis usage in surgery wards of tertiary level institution before and after the implementation of clinical guidelines",
abstract = "Background: Wound infections are the commonest hospital-acquired infections in surgical patients. Approximately 30-50{\%} of antibiotic use in hospitals, is now for surgical prophylaxis. However, between 30-90{\%} of this prophylaxis is inappropriate, that increases the selective pressure favoring the emergence of antimicrobial resistance. Judicious use of antibiotics in the hospital through effective antibiotic policy and guideline development is thus essential. Aims: To prepare a guideline for surgical antibiotic prophylaxis and to evaluate the impact of it in clinical practice. Settings and Design: A retrospective and prospective study was carried out over a nine month period, in a surgical unit of a tertiary care institution. Materials and Methods: An antibiogram was prepared to evaluate the sensitivity pattern retrospectively. A prospective study was done to evaluate the prescription pattern of antibiotic prophylaxis and incidence of surgical site infection. A draft guideline was prepared with expertise by the surgeon. Standardized recommendations in the guideline were done by the nominal group technique. Post-recommendation evaluation was done to observe the impact of the guideline in clinical practice. Results and Conclusions: 222 cases were evaluated during the pre-recommendation period, of which 21 were infected with surgical site infections that were rated as 9.45{\%}. Use of prophylactic antibiotics was widespread and inconsistent with published guidelines. 56 cases were evaluated during the post-recommendation period. None of the cases were infected. Prophylactic antibiotic use was consistent with respect to choice and duration. The study showed the importance of a multidisciplinary approach in implementing local guidelines in healthcare institutions, as per their hospital antimicrobial sensitivity pattern and expert′s opinions.",
author = "S. Khan and P. Rao and A. Rao and G. Rodrigues",
note = "Cited By :6 Export Date: 10 November 2017 CODEN: IJSUA Correspondence Address: Khan, S.; Department of Pharmacy Practice, S. S. Cancer Hospital and Research Centre, Manipal - 576104, Karnataka, India; email: sohailkhan1981@gmail.com References: Burke, J.P., Infection control - A problem for patient safety (2003) N Engl J Med, 348, pp. 651-656; Graham, J.C., Pedler, S.J., Surgical antibiotic prophylaxis (2003) Clinical Pharmacy and Therapeutics. 3 rd Ed., pp. 569-581. , Walker R, Edwards C, editors. Churchill Livingstone: London; John, W.D., Salmaan, K., Stephen, W.T., Antimicrobial prophylaxis in surgery (2002) Pharmacotherapy: A Pathophysiologic Approach. 5 th Ed., pp. 2111-2122. , Joseph TD, Robert LL, Gary CY, editors. McGraw Hill Publications: New York; Sasse, A., Mertens, R., Sion, J.P., Ronveaux, O., Bossens, M., De Mol, P., Surgical prophylaxis in Belgian hospitals: Estimate of costs and potential savings (1998) J Antimicrob Chemother, 41, pp. 267-272; Nguyen, D., Macleod, W.B., Phung, D.C., Cong, Q.T., Nguy, V.H., Van Nguyen, H., Incidence and predictors of surgical site infections in Vietnam (2001) Infect Control Hosp Epidemiol, 22, pp. 485-492; Sohn, A.H., Parvez, F.M., Vu, T., Hai, H.H., Bich, N.N., Le Thu, T.A., Prevalence of surgical site infections and patterns of antimicrobial use in a large tertiary care hospital in the Ho Chi Minh city, Vietnam (2002) Infect Control Hosp Epidemiol, 23, pp. 382-387; Saito, T., Aoki, Y., Ebara, K., Hirai, S., Kitamura, Y., Kasaoka, Y., Surgical-site infection surveillance at a small-scale community hospital (2005) J Infect Chemother, 11, pp. 204-206; Haley, R.W., Culver, D.H., Morgan, W.M., White, J.W., Emori, T.G., Hooton, T.M., Identifying patients at high risk of surgical wound infection: A simple multivariate index of patient susceptibility and wound contamination (1985) Am J Epidemiol, 121, pp. 206-215; Olson, M.M., Lee Jr., J.T., Continuous 10 year wound infection surveillance. Results, advantages and unanswered questions (1990) Arch Surg, 125, pp. 794-803; Soleto, L., Pirard, M., Boelaert, M., Peredo, R., Vargas, R., Gianella, A., Incidence of surgical-site infections and the validity of the National Nosocomial Infections Surveillance System risk index in a general surgical ward in Santa Cruz, Bolivia (2003) Infect Control Hosp Epidemiol, 24, pp. 26-30; Arias, C.A., Quintero, G., Vanegas, B.E., Rico, C.L., Patino, J.F., Surveillance of surgical site infections: Decade of experience at a Colombian tertiary care center (2003) World J Surg, 27, pp. 529-533; Eriksen, H.M., Chugulu, S., Kondo, S., Lingaas, E., Surgical-site infections at Kilimanjaro Christian Medical Center (2003) J Hosp Infect, 55, pp. 14-20; Jovanovic, B., Mazic, N., Mioljevic, V., Obrenovic, J., Jovanovic, S., Nosocomial infections in the intensive care units (2006) Vojnosanit Pregl, 63, pp. 132-136; Kasatpibal, N., Jamulitrat, S., Chongsuvivatwong, V., Standardized incidence rates of surgical site infection: A multicenter study in Thailand (2005) Am J Infect Control, 33, pp. 587-594; Lilani, S.P., Jangale, N., Chowdhary, A., Daver, G.B., Surgical site infection in clean and clean-contaminated cases (2005) Indian J Med Microbiol, 23, pp. 249-252; Murthy, R., Sengupta, S., Maya, N., Shivananda, P.G., Incidence of post operative wound infection and their antibiogram in a teaching and referral hospital (1998) Indian Med Sci, 52, pp. 553-555; Del Giudice, P., Blanc, V., Durupt, F., Bes, M., Martinez, J.P., Counillon, E., Emergence of two populations of methicillin-resistant Staphylococcus aureus with distinct epidemiological, clinical and biological features, isolated from patients with community-acquired skin infections (2006) Br J Dermatol, 154, pp. 118-124; John, M.B., John, E.P., Thomas, V.B., (2000) Antibacterial Prophylaxis in Surgery. The Surgeons Guide to Antimicrobial Chemotherapy, pp. 114-120. , Arnold Publications: London; Page, C.P., Bohnen, J.M., Fletcher, J.R., McManus, A.T., Solomkin, J.S., Wittmann, D.H., Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care (1993) Arch Surg, 128, pp. 79-88; Roy, M.-C., The operating room (2004) A Guide to Infection Control in the Hospital, pp. 114-119. , Wenzel R, Brewer T, Butzler JP, editors. International Society for Infectious Diseases: Boston; Matuschka, P.R., Cheadle, W.G., Burke, J.D., Garrison, R.N., A new standard of care: Administration of preoperative antibiotics in the operating room (1997) Am Surg, 63, pp. 500-503; Talon, D., Mourey, F., Touratier, S., Marie, O., Arlet, G., Decazes, J.M., Evaluation of current practices in surgical antimicrobial prophylaxis before and after implementation of local guidelines (2001) J Hosp Infect, 49, pp. 193-198",
year = "2006",
language = "English",
volume = "68",
pages = "150--156",
journal = "Indian Journal of Surgery",
issn = "0019-5650",
publisher = "Scientific Publishers of India",
number = "3",

}

TY - JOUR

T1 - Survey and evaluation of antibiotic prophylaxis usage in surgery wards of tertiary level institution before and after the implementation of clinical guidelines

AU - Khan, S.

AU - Rao, P.

AU - Rao, A.

AU - Rodrigues, G.

N1 - Cited By :6 Export Date: 10 November 2017 CODEN: IJSUA Correspondence Address: Khan, S.; Department of Pharmacy Practice, S. S. Cancer Hospital and Research Centre, Manipal - 576104, Karnataka, India; email: sohailkhan1981@gmail.com References: Burke, J.P., Infection control - A problem for patient safety (2003) N Engl J Med, 348, pp. 651-656; Graham, J.C., Pedler, S.J., Surgical antibiotic prophylaxis (2003) Clinical Pharmacy and Therapeutics. 3 rd Ed., pp. 569-581. , Walker R, Edwards C, editors. Churchill Livingstone: London; John, W.D., Salmaan, K., Stephen, W.T., Antimicrobial prophylaxis in surgery (2002) Pharmacotherapy: A Pathophysiologic Approach. 5 th Ed., pp. 2111-2122. , Joseph TD, Robert LL, Gary CY, editors. McGraw Hill Publications: New York; Sasse, A., Mertens, R., Sion, J.P., Ronveaux, O., Bossens, M., De Mol, P., Surgical prophylaxis in Belgian hospitals: Estimate of costs and potential savings (1998) J Antimicrob Chemother, 41, pp. 267-272; Nguyen, D., Macleod, W.B., Phung, D.C., Cong, Q.T., Nguy, V.H., Van Nguyen, H., Incidence and predictors of surgical site infections in Vietnam (2001) Infect Control Hosp Epidemiol, 22, pp. 485-492; Sohn, A.H., Parvez, F.M., Vu, T., Hai, H.H., Bich, N.N., Le Thu, T.A., Prevalence of surgical site infections and patterns of antimicrobial use in a large tertiary care hospital in the Ho Chi Minh city, Vietnam (2002) Infect Control Hosp Epidemiol, 23, pp. 382-387; Saito, T., Aoki, Y., Ebara, K., Hirai, S., Kitamura, Y., Kasaoka, Y., Surgical-site infection surveillance at a small-scale community hospital (2005) J Infect Chemother, 11, pp. 204-206; Haley, R.W., Culver, D.H., Morgan, W.M., White, J.W., Emori, T.G., Hooton, T.M., Identifying patients at high risk of surgical wound infection: A simple multivariate index of patient susceptibility and wound contamination (1985) Am J Epidemiol, 121, pp. 206-215; Olson, M.M., Lee Jr., J.T., Continuous 10 year wound infection surveillance. Results, advantages and unanswered questions (1990) Arch Surg, 125, pp. 794-803; Soleto, L., Pirard, M., Boelaert, M., Peredo, R., Vargas, R., Gianella, A., Incidence of surgical-site infections and the validity of the National Nosocomial Infections Surveillance System risk index in a general surgical ward in Santa Cruz, Bolivia (2003) Infect Control Hosp Epidemiol, 24, pp. 26-30; Arias, C.A., Quintero, G., Vanegas, B.E., Rico, C.L., Patino, J.F., Surveillance of surgical site infections: Decade of experience at a Colombian tertiary care center (2003) World J Surg, 27, pp. 529-533; Eriksen, H.M., Chugulu, S., Kondo, S., Lingaas, E., Surgical-site infections at Kilimanjaro Christian Medical Center (2003) J Hosp Infect, 55, pp. 14-20; Jovanovic, B., Mazic, N., Mioljevic, V., Obrenovic, J., Jovanovic, S., Nosocomial infections in the intensive care units (2006) Vojnosanit Pregl, 63, pp. 132-136; Kasatpibal, N., Jamulitrat, S., Chongsuvivatwong, V., Standardized incidence rates of surgical site infection: A multicenter study in Thailand (2005) Am J Infect Control, 33, pp. 587-594; Lilani, S.P., Jangale, N., Chowdhary, A., Daver, G.B., Surgical site infection in clean and clean-contaminated cases (2005) Indian J Med Microbiol, 23, pp. 249-252; Murthy, R., Sengupta, S., Maya, N., Shivananda, P.G., Incidence of post operative wound infection and their antibiogram in a teaching and referral hospital (1998) Indian Med Sci, 52, pp. 553-555; Del Giudice, P., Blanc, V., Durupt, F., Bes, M., Martinez, J.P., Counillon, E., Emergence of two populations of methicillin-resistant Staphylococcus aureus with distinct epidemiological, clinical and biological features, isolated from patients with community-acquired skin infections (2006) Br J Dermatol, 154, pp. 118-124; John, M.B., John, E.P., Thomas, V.B., (2000) Antibacterial Prophylaxis in Surgery. The Surgeons Guide to Antimicrobial Chemotherapy, pp. 114-120. , Arnold Publications: London; Page, C.P., Bohnen, J.M., Fletcher, J.R., McManus, A.T., Solomkin, J.S., Wittmann, D.H., Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care (1993) Arch Surg, 128, pp. 79-88; Roy, M.-C., The operating room (2004) A Guide to Infection Control in the Hospital, pp. 114-119. , Wenzel R, Brewer T, Butzler JP, editors. International Society for Infectious Diseases: Boston; Matuschka, P.R., Cheadle, W.G., Burke, J.D., Garrison, R.N., A new standard of care: Administration of preoperative antibiotics in the operating room (1997) Am Surg, 63, pp. 500-503; Talon, D., Mourey, F., Touratier, S., Marie, O., Arlet, G., Decazes, J.M., Evaluation of current practices in surgical antimicrobial prophylaxis before and after implementation of local guidelines (2001) J Hosp Infect, 49, pp. 193-198

PY - 2006

Y1 - 2006

N2 - Background: Wound infections are the commonest hospital-acquired infections in surgical patients. Approximately 30-50% of antibiotic use in hospitals, is now for surgical prophylaxis. However, between 30-90% of this prophylaxis is inappropriate, that increases the selective pressure favoring the emergence of antimicrobial resistance. Judicious use of antibiotics in the hospital through effective antibiotic policy and guideline development is thus essential. Aims: To prepare a guideline for surgical antibiotic prophylaxis and to evaluate the impact of it in clinical practice. Settings and Design: A retrospective and prospective study was carried out over a nine month period, in a surgical unit of a tertiary care institution. Materials and Methods: An antibiogram was prepared to evaluate the sensitivity pattern retrospectively. A prospective study was done to evaluate the prescription pattern of antibiotic prophylaxis and incidence of surgical site infection. A draft guideline was prepared with expertise by the surgeon. Standardized recommendations in the guideline were done by the nominal group technique. Post-recommendation evaluation was done to observe the impact of the guideline in clinical practice. Results and Conclusions: 222 cases were evaluated during the pre-recommendation period, of which 21 were infected with surgical site infections that were rated as 9.45%. Use of prophylactic antibiotics was widespread and inconsistent with published guidelines. 56 cases were evaluated during the post-recommendation period. None of the cases were infected. Prophylactic antibiotic use was consistent with respect to choice and duration. The study showed the importance of a multidisciplinary approach in implementing local guidelines in healthcare institutions, as per their hospital antimicrobial sensitivity pattern and expert′s opinions.

AB - Background: Wound infections are the commonest hospital-acquired infections in surgical patients. Approximately 30-50% of antibiotic use in hospitals, is now for surgical prophylaxis. However, between 30-90% of this prophylaxis is inappropriate, that increases the selective pressure favoring the emergence of antimicrobial resistance. Judicious use of antibiotics in the hospital through effective antibiotic policy and guideline development is thus essential. Aims: To prepare a guideline for surgical antibiotic prophylaxis and to evaluate the impact of it in clinical practice. Settings and Design: A retrospective and prospective study was carried out over a nine month period, in a surgical unit of a tertiary care institution. Materials and Methods: An antibiogram was prepared to evaluate the sensitivity pattern retrospectively. A prospective study was done to evaluate the prescription pattern of antibiotic prophylaxis and incidence of surgical site infection. A draft guideline was prepared with expertise by the surgeon. Standardized recommendations in the guideline were done by the nominal group technique. Post-recommendation evaluation was done to observe the impact of the guideline in clinical practice. Results and Conclusions: 222 cases were evaluated during the pre-recommendation period, of which 21 were infected with surgical site infections that were rated as 9.45%. Use of prophylactic antibiotics was widespread and inconsistent with published guidelines. 56 cases were evaluated during the post-recommendation period. None of the cases were infected. Prophylactic antibiotic use was consistent with respect to choice and duration. The study showed the importance of a multidisciplinary approach in implementing local guidelines in healthcare institutions, as per their hospital antimicrobial sensitivity pattern and expert′s opinions.

M3 - Article

VL - 68

SP - 150

EP - 156

JO - Indian Journal of Surgery

JF - Indian Journal of Surgery

SN - 0019-5650

IS - 3

ER -