K-587. Evaluation of Perioperative Antimicrobial Prophylaxis Among Six Italian Hospitals: The Pap-Inf Study
Session: Poster Session: Surgical Site Infections: Trials and Tribulations
Saturday, October 25, 2008: 12:00 AM
Room: Hall C
Background: Appropriate perioperative antimicrobial prophylaxis (PAP) has been shown to decrease morbidity and mortality related to surgical site infections (SSI). Our study aimed to assess the quality of PAP and to develop approaches to its improvement. Methods: Retrospective study in 19 randomly selected surgical wards among 6 North Italian hospitals. We evaluated rates of PAP on indication or not, and quality of PAP in respect to timely administration (initiation and duration) and to adequate choice of antimicrobials. Results: A total of 533 patients were included; 58.5% males, median age 60 years (range 8-103). Hospital wards were: general surgery (40%), orthopaedics (21%), neurosurgery (11%), cardiothoracic and vascular surgery (11%), gynecologic surgery (6%). Main concomitant diseases were cardiovascular diseases (19%), diabetes (7%) and cancer (4%). On a total of 494 valuables patients, PAP was on indication in 71%, neither indicated or done in 15%, indicated but not done in 7%, not indicated but done in 7%. Among those patients with PAP on indication, in 21% either doses and/or antimicrobial choice were judged to be inadequate; in 20% the first dose was not administered within 1 hour before surgical incision; in 33% of patients PAP was not discontinued within 24h after the end of surgery.
Conclusions: In a substantial percentage of patients, PAP was inadequate either on indication, or on doses, antimicrobial choice and timely administration. Attempts to correct this attitude should be pursued in order to improve clinical care and to reduce antimicrobial-related resistance selection and costs.
Antonella d'ARMINIO MONFORTE1, Chiara Erba1, D Vlacos2, Fabio Franzetti3, Federica Tordato4, Gian Marco Vigevani5, Paolo Vigano'6, Silvia Magri1, Tiziana Quirino7 and  F. Tordato, None., (1)Clinic of Infectious Diseases, (2)Azienda Ospedaliera Provincia di Pavia, (3)Clinic of Infectious Diseases,Univ of Milan, Sacco Hospital, (4)Clinic of Infectious Diseases, Milan, Italy, (5)1st Dept Infect Dis, Sacco Hosp, (6)Dept Infect Dis, Legnano Hosp, (7)Dept Infect Dis, Busto Arsizio Hosp