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A National Survey of Surgical Antibiotic Prophylaxis in Turkey

Published online by Cambridge University Press:  02 January 2015

Salih Hosoglu*
Affiliation:
Dicle University Hospital, Diyarbakir, Turkey
Mustafa Sunbul
Affiliation:
Ondokuz Mayis University Hospital, Samsun, Turkey
Serpil Erol
Affiliation:
Ataturk University Hospital, Erzurum, Turkey
Mustafa Altindis
Affiliation:
Kocatepe University Hospital, Afyon, Turkey
Rahmet Caylan
Affiliation:
Farabi Hospital, Trabzon, Turkey
Kutbettin Demirdag
Affiliation:
Firat University Hospital, Elazig, Turkey
Hasan Ucmak
Affiliation:
Dicle University Hospital, Diyarbakir, Turkey
Havva Mendes
Affiliation:
Dicle University Hospital, Diyarbakir, Turkey
Mehmet Faruk Geyik
Affiliation:
Dicle University Hospital, Diyarbakir, Turkey
Huseyin Turgut
Affiliation:
Pamukkale University Hospital, Denizli, Turkey
Sibel Gundes
Affiliation:
Kocaeli University Hospital, Kocaeli, Turkey
Elif Kartal Doyuk
Affiliation:
Osman Gazi University Hospital, Eskisehir, Turkey
Mustafa Aldemir
Affiliation:
Dicle University Hospital, Diyarbakir, Turkey
Ali ihsan Dokucu
Affiliation:
Dicle University Hospital, Diyarbakir, Turkey
*
Dicle Universitesi Hastanesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Anabilim Dali, 21280, Diyarbakir, Turkey

Abstract

Objective:

To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures.

Design:

A cross-sectional, country-wide survey.

Setting:

Thirty-six hospitals in 12 cities in Turkey.

Participants:

Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest.

Methods:

A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures.

Results:

Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (26%) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426–3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890–8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95, 0.225–0.772; P < .001) were associated with inappropriate prophylaxis.

Conclusion:

Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Woods, RK, Dellinger, ER. Current guidelines for antibiotic prophylaxis of surgical wounds. Am Fam Physician 1998;57:27312740.Google ScholarPubMed
2.Gyssens, IC. Preventing postoperative infections: current treatment recommendations. Drugs 1999;57:175185.Google Scholar
3.Scher, KS. Studies on the duration of antibiotic administration for surgical prophylaxis. Am Surg 1997;63:5962.Google Scholar
4.Silver, A, Eichorn, A, Kral, J, et al.Timeliness and use of antibiotic prophylaxis in selected inpatients' surgical procedures. Am J Surg 1996;171:548552.CrossRefGoogle ScholarPubMed
5.Pestotnik, SL, Classen, DC, Evans, RS, Burke, JR. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med 1996;124:884890.CrossRefGoogle ScholarPubMed
6.Classen, DC, Evans, RS, Pestotnik, SL, Horn, SD, Menlove, RL, Burke, JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281286.Google Scholar
7.Thomas, M, Govil, S, Moses, BV, Joseph, A. Monitoring of antibiotic use in a primary and a tertiary care hospital. J Clin Epidemiol 1996;49:251254.Google Scholar
8.Burke, JP. Maximizing appropriate antibiotic prophylaxis for surgical patients: an update from LDS Hospital, Salt Lake City. Clin Infect Dis 2001;33(suppl 2):S78S83.Google Scholar
9.Akalin, HE. Surgical prophylaxis: the evolution of guidelines in an era of cost containment. J Hosp Infect 2002;50(suppl A):S3S7.Google Scholar
10.Page, CP, Bohnen, JMA, Fletcher, JR, McManus, AT, Solomkin, JS, Wittmann, DH. Antimicrobial prophylaxis for surgical wounds: guidelines for clinical care. Arch Surg 1993;128:7988.Google Scholar
11.Haley, RW, Culver, DH, Morgan, WM, White, JW, Emori, TG, Hooton, TM. Identifying patients at high risk of surgical wound infection. Am J Epidemiol 1985;121:206215.Google Scholar
12.Yerdel, MA, Akin, EB, Dolalan, S, et al.Effect of single-dose prophylactic ampicillin and sulbactam on wound infection after tension-free inguinal hernia repair with polypropylene mesh: the randomized, double-blind, prospective trial. Ann Surg 2001;233:2633.Google Scholar
13.Ranaboldo, CJ, Karran, SE, Bailey, IS, Karran, SJ. Antimicrobial prophylaxis in ‘clean’ surgery: hernia repair. J Antimicrob Chemother 1993;31(suppl B):3541.CrossRefGoogle ScholarPubMed
14.Ehrenkranz, NJ, Blackwelder, WC, Pfaff, SJ, Poppe, D, Yerg, DE, Kaslow, RA. Infections complicating low-risk cesarean sections in community hospitals: efficacy of antimicrobial prophylaxis. Am J Obstet Gynecol 1990;162:337343.CrossRefGoogle ScholarPubMed
15.Yalcin, AN, Serin, S, Gurses, E, Zencir, M. Surgical antibiotic prophylaxis in a Turkish university hospital. J Chemother 2002; 14:373377.CrossRefGoogle Scholar
16.Heineck, I, Ferreira, MB, Schenkel, EP. Prescribing practice for antibiotic prophylaxis for 3 commonly performed surgeries in a teaching hospital in Brazil. Am J Infect Control 1999;27:296300.CrossRefGoogle Scholar
17.Gorecki, P, Schein, M, Rucinski, JC, Wise, L. Antibiotic administration in patients undergoing common surgical procedures in a community teaching hospital: the chaos continues. World J Surg 1999;23:429432.Google Scholar
18.Thomas, JA, Martin, V, Frank, S. Improving pharmacy supply-chain management in the operating room. Healthcare Financial Management 2000;54:5861.Google ScholarPubMed
19.Martin, C, Pourriat, JL. Quality of perioperative antibiotic administration by French anaesthetists. J Hosp Infect 1998;40:4753.Google Scholar
20.Codina, C, Trilla, A, Riera, N, et al.Perioperative antibiotic prophylaxis in Spanish hospitals: results of a questionnaire survey. Infect Control Hosp Epidemiol 1999;20:436439.Google Scholar
21.Gyssens, IC, Geerligs, IE, Nannini-Bergman, MG, Knape, JT, Hekster, YA, van der Meer, JWM. Optimizing the timing of antimicrobial prophylaxis in surgery, an intervention study. J Antimicrob Chemother 1996;38:301308.Google Scholar