Surgical antibiotic prophylaxis: is the clinical practice based on evidence?

ABSTRACT Objective: To assess the surgical antibiotic prophylaxis. Methods: This was a descriptive study performed at a public tertiary care university hospital gathering prescription, sociodemographic and hospitalization data of inpatients admitted in 2014 who used antimicrobial drugs. This data were obtained from the hospital electronic database. The antimicrobial data were classified according to the anatomical, therapeutic chemical/defined daily dose per 1,000 inpatients. An exploratory analysis was performed using principal component analysis. Results: A total of 5,182 inpatients were prescribed surgical antibiotic prophylaxis. Of the total antimicrobial use, 11.7% were for surgical antibiotic prophylaxis. The orthopedic, thoracic and cardiovascular postoperative units, and postoperative intensive care unit comprised more than half of the total surgical antibiotic prophylaxis use (56.3%). The duration of antimicrobial use of these units were 2.2, 2.0, and 1.4 days, respectively. Third-generation cephalosporins and fluoroquinolones had the longest use among antimicrobial classes. Conclusion: Surgical antibiotic prophylaxis was inadequate in the orthopedic, postoperative intensive care, thoracic and cardiovascular postoperative, gynecology and obstetrics, and otolaryngology units. Therefore, the development and implementation of additional strategies to promote surgical antibiotic stewardship at hospitals are essential.摘要 研究目的：评估手术抗菌药物预防（surgical antibiotic prophylaxis）的应用情况。 研究方法：本研究为描述性研究，在某公立三级教学医院开展，收集2014年入院且使用抗菌药物的住院患者的处方、社会人口学特征及住院相关数据，数据均来源于医院电子数据库。抗菌药物数据依据解剖学治疗学化学分类系统（Anatomical Therapeutic Chemical，ATC）及每千住院患者限定日剂量（defined daily dose，DDD）进行分类，并采用主成分分析（principal component analysis，PCA）开展探索性分析。 研究结果：共计5182名住院患者接受了手术抗菌药物预防用药；在整体抗菌药物使用中，11.7%为手术抗菌药物预防用药。骨科术后、胸外科术后、心血管术后病房及术后重症监护病房的手术抗菌药物预防用药量占总用量的56.3%，超过总用量的一半。上述病房的抗菌药物使用时长分别为2.2天、2.0天及1.4天。第三代头孢菌素与氟喹诺酮类为使用时长最长的抗菌药物类别。 研究结论：骨科、术后重症监护、胸外科与心血管术后、妇产科及耳鼻喉科病房的手术抗菌药物预防用药存在不规范情况。因此，制定并实施更多推动医院外科抗菌药物管理的策略至关重要。