Appropriateness of antibiotic prophylaxis in the surgical wards of a Teaching Hospital in Rome

Background Surgical site infections (SSIs) are a major contributor to patient injury, mortality and health care costs. There is a strong evidence of effectiveness of antimicrobial prophylaxis and the spread availability of national and international guidelines, its use is often suboptimal. Classically inappropriateness in antibiotic prophylaxis is associated with lower safety, efficiency and higher cost. Our study evaluates the appropriateness of prescription of antibiotics prophylaxis in surgical hospitalized patients in a big Italian research and teaching hospital (R&TH). Methods An observational-retrospective study was conducted through the investigation of the medical records of all the patients undergoing surgery in two not-consecutive weeks period from March to April 2013. Medical records were investigated on day 3 and 7 after surgery in order to evaluate the appropriateness of administration of antibiotic prescription. Patients with a suspected or established infection before surgery were excluded from the evaluation. Appropriateness was measured in terms of adherence to type, time and duration according to surgical antimicrobial prophylaxis guidelines (Bratzler 2013). Results 672 surgical procedures were evaluated. We observed in 12.9% of the cases a prophylaxis not performed even if indicated by guidelines. Conversely, an antibiotic prophylaxis was performed, even if not indicated in 21% of cases. A complete adherence to guidelines was observed in 57.3% of the cases. The right type of antimicrobial agent, according to guidelines, was chosen in 94.1% of the cases. The appropriateness of “timing” (from 180 to 15 minutes before the procedure) was detected in 71.4% of the records while the appropriateness of duration (one-shot therapy in almost all the operations but cardiac surgery) was found in 69.3% of the cases. Conclusion The appropriateness of antibiotic prophylaxis in the R&TH, even if comparable with other international experiences, still needs to be implemented. Importantly, the issue of prophylaxis given when not indicated (excess of therapy), or not given when indicated (defect of therapy), other than type-time-duration appropriateness, needs to be always take into consideration while evaluating the correct use of antibiotic prophylaxis for surgery. Key messages Healthcare providers should be aware of their key role in reducing inappropriate prescription in surgical antimicrobial prophylaxis. Adherence to guidelines ought to be explored also through the evaluation of excess or defect of prescription, alongside appropriateness in terms of type, duration and time.