Abstract
Background
This study aimed to evaluate the quality of surgical antibiotic prophylaxis (SAP) in a tertiary hospital.
Methods
Medical, anesthetic, and nursing records from the 27,320 procedures conducted in a tertiary hospital during 2012 were retrospectively reviewed. Three clinical performance indicators of SAP (selection of antibiotic, timing of the first administration, duration of prophylaxis) were included as part of the National Hospital Evaluation Program (NHEP) of the Health Insurance Review and Assessment Service. In addition, 2 other parameters were assessed according to recent guidelines (weight-based initial dosing for obesity, intraoperative re-dosing for excessive blood loss, and prolonged duration of procedures).
Results
Prophylactic antibiotics were administered in 19,637 (71.8%) of 27,320 total procedures. Quality of the 3 performance indicators was higher in the types of operations included in NHEP than in other procedures. However, additional doses were administered in 15 (1.2%) of 1,299 surgical procedures that lasted more than twice the half-life of the antibiotic used, and in 9 (3.3%) of 273 procedures with excessive blood loss greater than 1,500 mL. NHEP and non-NHEP results did not differ significantly.
References
1. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009; 37:387–97.
2. Steinberg JP, Braun BI, Hellinger WC, Kusek L, Bozikis MR, Bush AJ, Trial to Reduce Antimicrobial Prophylaxis Errors (TRAPE) Study Group, et al. Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the Trial to Reduce Antimicrobial Prophylaxis Errors. Ann Surg. 2009; 250:10–6.
3. Weber WP, Marti WR, Zwahlen M, Misteli H, Rosenthal R, Reck S, et al. The timing of surgical antimicrobial prophylaxis. Ann Surg. 2008; 247:918–26.
4. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013; 70:195–283.
5. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999; 20:250–78.
6. McDonald M, Grabsch E, Marshall C, Forbes A. Single- versus multiple-dose antimicrobial prophylaxis for major surgery: a systematic review. Aust N Z J Surg. 1998; 68:388–96.
7. ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery.American Society of Health-System Pharmacists. Am J Health Syst Pharm. 1999; 56:1839–88.
8. Bratzler DW, Houck PM; Surgical Infection Prevention Guidelines Writers Workgroup; American Academy of Orthopaedic Surgeons; American Association of Critical Care Nurses; American Association of Nurse Anesthetists; American College of Surgeons; American College of Osteopathic Surgeons; American Geriatrics Society; American Society of Anesthesiologists; American Society of Colon and Rectal Surgeons; American Society of Health-System Pharmacists; American Society of PeriAnesthesia Nurses; Ascension Health; Association of periOperative Registered Nurses; Association for Professionals in Infection Control and Epidemiology; Infectious Diseases Society of America; Medical Letter; Premier; Society for Healthcare Epidemiology of America; Society of Thoracic Surgeons; Surgical Infection Society. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004; 38:1706–15.
9. Zelenitsky SA, Ariano RE, Harding GK, Silverman RE. Antibiotic pharmacodynamics in surgical prophylaxis: an association between intraoperative antibiotic concentrations and efficacy. Antimicrob Agents Chemother. 2002; 46:3026–30.
10. Edmiston CE, Krepel C, Kelly H, Larson J, Andris D, Hennen C. et al. Perioperative antibiotic prophylaxis in the gastric bypass patient: do we achieve therapeutic levels? Surgery. 2004; 136:738–47.
11. Choi WS, Song JY, Hwang JH, Kim NS, Cheong HJ. Appropriateness of antibiotic prophylaxis for major surgery in Korea. Infect Control Hosp Epidemiol. 2007; 28:997–1002.
12. Sakong P, Lee JS, Lee EJ, Ko KP, Kim CH, Kim Y, et al. Association between the pattern of prophylactic antibiotic use and surgical site infection rate for major surgeries in Korea. J Prev Med Public Health. 2009; 42:12–20.
13. Health Insurance Review & Assessment Service.HIRA web site on information. Quality assessment of the use of prophylactic antibiotics for surgery in 2012. http://www.hira.or.kr/.
14. Korean society for the study of obesity.Guideline for obesity 2012. Seoul: Korean society for the study of obesity. 2012; 17–21.
15. World Health Organization.Obesity. http://www.who.int/topics/obesity/en/.
16. Kim ES, Park SW, Lee CS, Gyung Kwak Y, Moon C, Kim BN. Impact of a national hospital evaluation program using clinical performance indicators on the use of surgical antibiotic prophylaxis in Korea. Int J Infect Dis. 2012; 16:e187–92.
17. Yoo S, Kim S, Lee KH, Jeong CW, Youn SW, Park KU, et al. Electronically implemented clinical indicators based on a data warehouse in a tertiary hospital: its clinical benefit and effectiveness. Int J Med Inform. 2014; 83:507–16.
18. Falagas ME, Karageorgopoulos DE. Adjustment of dosing of antimicrobial agents for body-weight in adults. Lancet. 2010; 375:248–51.
19. Pai MP, Bearden DT. Antimicrobial dosing considerations in obese adult patients. Pharmacotherapy. 2007; 27:1081–91.
20. Forse RA, Karam B, MacLean LD, Christou NV. Antibiotic prophylaxis for surgery in morbidly obese patients. Surgery. 1989; 106:750–6.
21. Scher KS. Studies on the duration of antibiotic administration for surgical prophylaxis. Am Surg. 1997; 63:59–62.
22. Morita S, Nishisho I, Nomura T, Fukushima Y, Morimoto T, Hiraoka N, et al. The significance of the intraoperative repeated dosing of antimicrobials for preventing surgical wound infection in colorectal surgery. Surg Today. 2005; 35:732–8.
23. Markantonis SL, Kostopanagiotou G, Panidis D, Smirniotis V, Voros D. Effects of blood loss and fluid volume replacement on serum and tissue gentamicin concentrations during colorectal surgery. Clin Ther. 2004; 26:271–81.
24. Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F, Workforce on Evidence-Based Medicine, Society of Thoracic Surgeons, et al. The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. Ann Thorac Surg. 2007; 83:1569–76.