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Application of ATC/DDD methodology to evaluate perioperative antimicrobial prophylaxis

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Abstract

Objective To evaluate quality of perioperative antibiotic prophylaxis (PAP) and to calculate the cost per procedure in a Turkish university hospital. Setting A 352-bed teaching hospital in Denizli, Turkey. Method An prospective audit was performed between July and October 2010. All clean, clean-contaminated and contaminated elective surgical procedures in ten surgical wards were recorded. Antimicrobial use was calculated per procedure using the ATC-DDD system. The appropriateness of antibiotic use for each procedure was evaluated according to international guidelines on PAP. In addition, the cost per procedure was calculated. Results Overall, in 577 of the 625 (92.3%) of the studied procedures, PAP was used. PAP was indicated in 12.5% of the group where it was not used, and not indicated in 7.1% of the group where it was used. Unnecessarily prolonged antimicrobial prophylaxis was observed in 56.9% of the procedures, mean duration was 2.6 ± 2.7 days. The most frequently used antimicrobials were cefazolin (117.9 DDD/100-operation) and sulbactam/ampicillin (102.2 DDD/100-operation). The timing of the starting dose was appropriate in 545 procedures (94.5%). In the group that received PAP, only 80 (13.7%) of the procedures were found to be fully appropriate and correct. The density of antimicrobial use per operation was 2.8 DDD. The mean cost of the use of prophylactic antimicrobials €18.6 per procedure. Conclusion The density of antimicrobial use in PAP was found to be very high in our hospital. Antibiotic overuse extended into the postoperative period.

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References

  1. Takahashi Y, Takesue Y, Nakajima K, Ichiki K, Wada Y, Tsuchida T, et al. Implementation of a hospital-wide project for appropriate antimicrobial prophylaxis. J Infect Chemother. 2010;16:418–23.

    Article  PubMed  CAS  Google Scholar 

  2. Bailly P, Lallemand S, Thouverez M, Talon D. Multicentre study on the appropriateness of surgical antibiotic prophylaxis. J Hosp Infect. 2001;49(2):135–8.

    Article  PubMed  CAS  Google Scholar 

  3. Mangram AJ, Horan TC, Parson ML, Silver LC, Jarvis WR. The Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20:247–78.

    Article  Google Scholar 

  4. American Society of Health-System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 1999; 56:1839–88.

    Google Scholar 

  5. Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WJ, McGowan JE Jr, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America. Clin Infect Dis. 1994;18:422–7.

    Article  CAS  Google Scholar 

  6. Gyssens IC. Preventing postoperative infections: current treatment recommendations. Drugs. 1999;57:175–85.

    Article  PubMed  CAS  Google Scholar 

  7. 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;23:429–32.

    Article  PubMed  CAS  Google Scholar 

  8. van Kasteren MEE, Kullberg BJ, Boer AS, Groot M, Gyssens IC. Adherence to local hospital guidelines for surgical antimicrobial prophylaxis: a multicentre audit in Dutch hospitals. J Antimicrob Chemother. 2003;51:1389–96.

    Article  PubMed  Google Scholar 

  9. Burke JP. Maximizing appropriate antibiotic prophylaxis for surgical patients: an update from LDS hospital, Salt Lake city. Clin Infect Dis. 2001;33(2):78–83.

    Article  Google Scholar 

  10. Hosoglu S, Sunbul M, Erol S, Altindis M, Caylan R, Demirdag K, et al. Surgical antibiotic prophylaxis in Turkey: a survey study. Infect Control Hosp Epidemiol. 2003;24:758–61.

    Article  PubMed  Google Scholar 

  11. Hosoglu S, Aslan S, Akalin S, Bosnak V. Audit of quality of perioperative antimicrobial prophylaxis. Pharm World Sci. 2009;31:14–7.

    Article  PubMed  Google Scholar 

  12. Yalcin AN, Erbay RH, Serin S, et al. Perioperative antibiotic prophylaxis and cost in a Turkish University Hospital. Infez Med. 2007;15(2):99–104.

    PubMed  Google Scholar 

  13. Ozgun H, Ertugrul BM, Soyder A, Ozturk B, Aydemir M. Peri-operative antibiotic prophylaxis: adherence to guidelines and effects of educational intervention. Int J Surg. 2010;8(2):159–63.

    Article  PubMed  Google Scholar 

  14. Yalcin AN, Serin S, Gurses E, Zencir M. Surgical antibiotic prophylaxis in a Turkish University Hospital. J Chemother. 2002;14:373–7.

    PubMed  CAS  Google Scholar 

  15. Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004;38:1706–15.

    Article  PubMed  Google Scholar 

  16. World Health Organization (WHO), Collaborating Center for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2010. Oslo, 2009. ISBN 978-82-8082-369. Available from, http://www.whocc.no/atcddd/. Accessed 14 June 2010.

  17. Vaccheri A, Silvani MC, Bersaglia L, et al. A 3 year survey on the use of antibacterial agents in five Italian hospitals. J Antimicrob Chemother. 2008;61(4):953–8.

    Article  PubMed  CAS  Google Scholar 

  18. van Kasteren MEE, Mannien J, Kullberg BJ, de Boer AS, Nagelkerke NJ, Ridderhof M, et al. Quality improvement of surgical prophylaxis in Dutch hospitals: evaluation of a multi-site intervention by time series analysis. J Antimicrob Chemother. 2005;56:1094–102.

    Article  PubMed  Google Scholar 

  19. 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;38:301–8.

    Article  PubMed  CAS  Google Scholar 

  20. Gomez MI, Acosta-Gnass SI, Barboza LM, Basualdo JA. Reduction in surgical antibiotic prophylaxis expenditure and the rate of surgical site infection by means of a protocol that controls the use of prophylaxis. Infect Control Hosp Epidemiol. 2006;27:1358–65.

    Article  PubMed  Google Scholar 

  21. Martin C, Pourriat JL. Quality of perioperative antibiotic administration by French anaesthetists. J Hosp Infect. 1998;40:47–53.

    Article  PubMed  CAS  Google Scholar 

  22. Bailly P, Lallemand S, Thouverez M, Talon D. Multicentre study on the appropriateness of surgical antibiotic prophylaxis. J Hosp Infect. 2001;49:135–8.

    Article  PubMed  CAS  Google Scholar 

  23. Chen YS, Liu YH, Kunin CM, Huang JK, Tsai CC. Use of prophylactic antibiotics in surgery at a medical center in southern Taiwan. J Formos Med Assoc. 2002;101:741–8.

    PubMed  Google Scholar 

  24. Prado MA, Lima MP, Gomes IR, Bergsten-Mendes G. The implementation of a surgical antibiotic prophylaxis program: the pivotal contribution of the hospital pharmacy. Am J Infect Control. 2002;30:49–56.

    Article  PubMed  Google Scholar 

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Acknowledgments

We are grateful to the Perioperative Antimicrobial Prophylaxis Study Group of the participating hospital for retrieving the surgical prophylaxis data. Members of the Perioperative Antimicrobial Prophylaxis Study Group: Ozer Oztekin, Ugur Koltuksuz, Ali Vefa Ozcan, Funda Tumkaya, Gokhan Yuncu, Koray Tekin, Ilkay Sitti, Gungor Bingolo, Orhan Aydin, Veysel Baskan, Umit Cabus, Firat Durna, Bulent Kamil Akyol, Yasin Ekinci and Seda Arzuman.

Funding

No financial support was provided for this study.

Conflicts of interest

The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kinikli Kampusu, Pamukkale University, 20070, Denizli, Turkey

    Serife Akalin & Selda Sayin Kutlu

  2. Faculty of Medicine, Department of Neurosurgery, Pamukkale University, Denizli, Turkey

    Bayram Cirak

  3. Faculty of Medicine, Department of Urology, Pamukkale University, Denizli, Turkey

    Saadettin Yilmaz Eskiçorapcı

  4. Faculty of Medicine, Department of Plastics Surgery, Pamukkale University, Denizli, Turkey

    Dilek Bagdatli

  5. Faculty of Medicine, Department of Orthopedics, Pamukkale University, Denizli, Turkey

    Semih Akkaya

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  1. Serife Akalin
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  2. Selda Sayin Kutlu
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  3. Bayram Cirak
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  4. Saadettin Yilmaz Eskiçorapcı
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  5. Dilek Bagdatli
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  6. Semih Akkaya
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Correspondence to Serife Akalin.

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Akalin, S., Kutlu, S.S., Cirak, B. et al. Application of ATC/DDD methodology to evaluate perioperative antimicrobial prophylaxis. Int J Clin Pharm 34, 120–126 (2012). https://doi.org/10.1007/s11096-011-9601-3

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  • DOI: https://doi.org/10.1007/s11096-011-9601-3

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