Session: Poster Session: Antibiotic Stewardship
Sunday, October 26, 2008: 12:00 AM
Room: Hall C
Background: Perioperative antibiotic prophylaxis (PAP) is a cornerstone of good care in surgery. A multicentric protocol for PAP including 7 major hospitals in North Italy (986 beds each on average) was designed. Data regarding PAP management before protocol implementation are reported.Methods: 2786 clinical charts randomly collected from surgical activities in 2006 were analysed. An evaluation scoring system verified the adherence to current local protocol, if any, in each hospital. The criteria of appropriateness of PAP were a) the choice of drug b) the dosage c) the time of administration d) the administration of an intraoperative dose in procedures lasting more than 4 hours. Results: PAP was administered in 72.1% of procedures: 586 procedures had no protocol. PAP was either performed or omitted correctly in 1808/2200 (82.2% = 67.9% correctly administered + 14.3% correctly omitted). 5% of PAP administered was given without indication. The appropriateness criteria (abc) were achieved in 51% of cases; criteria abc+d were fulfilled in 37% of cases. The drug choice was correct in 68.8% (range 20.8-91.7%), the drug dosage in 93.9% (60-100%) and timing in 74% (9.1-100%). Complete appropriateness rate (abc criteria +correctly omitted PAP) was 41%. Remarkably only 56% of PAP were strictly perioperative: in 21.5% of cases supplement doses exceeding 48 hours after the intervention date were given. Conclusions: PAP management varies significantly among distinct institutions. The need for common guidelines as well as surveillance measures in adherence are urgent in order to implement useful hospital antibiotic policies.