References
Prescribing practices of antimicrobial prophylaxis in older patients in the surgical wards
Abstract
Background:
appropriate prescribing of antimicrobial prophylaxis (AP) is a main strategy of the antimicrobial stewardship programme.
Aim:
to investigate the prescribing practices of antimicrobial prophylaxis and adherence to recommended protocols in older patients in the surgical wards at a 600-bed teaching hospital in Islamabad, Pakistan.
Method:
researchers selected 240 surgical procedures retrospectively for patients aged 65 years and older admitted to four surgical specialties (abdominal, orthopaedic, urological and neurosurgery) during 1 year. The different parameters of antimicrobial prescription were compared with international clinical practice guidelines.
Findings:
There were more ‘clean’ surgical wound procedures (n=104; 43.3%) than ‘clean contaminated’ (n=97; 40.4%) and most of these were elective surgical procedures (n=226; 94%). The indication, selection, route, dose, and timing of antimicrobial were found to have adhered with the standard guidelines in 89.6%, 32.5%, 100%, 100% and 55.3% of cases, respectively (optimal value 100%). A statistically significant difference was observed between antimicrobial practices and surgical procedures (P< 0.001). The commonly prescribed antimicrobials were ceftriaxone followed by cefazolin.
Conclusion:
about 89% of participants who underwent surgical procedures received antimicrobials. The selection of therapeutic agent, the timing and use of broad-spectrum antimicrobial were the common problems in our setting.
Post-surgical infections can be prevented through the effective use of antimicrobial prophylaxis (AP) (Goede et al, 2013; Foroutan and Foroutan, 2014; Wartiti et al, 2016; Berrios-Torres et al, 2017; Alemkere, 2018). About 20–30% of the overall consumption of antimicrobials in hospital are as prophylactics in surgery (Groselj Grenc et al, 2006; Alemkere, 2018). It is evident that the excessive prescribing of antimicrobials is responsible for the emergence of antimicrobial resistance; therefore, rational use is crucial for the reduction of problems related to resistance (Bisht et al, 2009; Foroutan and Foroutan, 2014; Berríos-Torres et al, 2017). Despite the availability of evidence-based guidelines for surgical prophylaxis, studies have reported unnecessary use of broad-spectrum agents and inappropriate timing of administration of antimicrobials worldwide (Groselj et al, 2006; Hosoglu et al, 2009; Vessal et al, 2011; Elbur et al, 2013; Goede et al, 2013; Pollmann et al, 2017; Alemkere, 2018; Karamachandani et al, 2019). Adherence to evidence-based guidelines is an essential element of hospital policy and patient safety (Wartiti et al, 2016).
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