A National Point Prevalence survey of antimicrobial prescribing for surgical prophylaxis
Abstract number: P1500
Objectives: An All-Wales Point Prevalence Survey (PPS) of antibacterial usage in secondary care was supported and carried out by pharmacists in twenty three hospitals across Wales during November/December 2008 to mark the first European Antibiotic Awareness Day. The data presented concentrates specifically on antimicrobial prescribing for surgical prophylaxis. The objective was to examine antimicrobial prescribing and duration of surgical prophylaxis.
Methods: Patients from 226 wards in 23 hospitals across Wales were included in the PPS. The number of patients surveyed on each ward, and the number prescribed antimicrobials at or before 8:00 am on the day of the PPS was recorded. Note: Not all hospitals surveyed all patients, and there was a bias towards surveying patients from medical wards. The auditors were asked to record the antimicrobial prescribed, site of infection, and duration of surgical prophylaxis based on the number of doses prescribed: Single dose; one day; >one day.
Results: Of the 4888 patients surveyed 1503 were prescribed systemic antimicrobial/s (31%); 206 patients were prescribed systemic antimicrobials for surgical prophylaxis (4.2%). Antimicrobial prescribing varied between hospitals dependant largely on specialties, with 22 different antimicrobials being prescribed. Cefuroxime was the most commonly prescribed antimicrobial (35.2% of total antimicrobials), which is of concern with regard to the association with Clostridium difficle infection. 85.2% of the antimicrobials prescribed for surgical prophylaxis were for IV administration. The proportion of patients receiving surgical prophylaxis for >one day ranged from 0100% with an All-Wales average of 48.2%. Prophylaxis prior to urinary tract surgery or bone & joint surgery was less likely to be prescribed for more than one day than for the other sites.
Conclusions: The Scottish Intercollegiate Guidelines Network guidelines for antibiotic prophylaxis in surgery state that 'a single standard therapeutic dose of antibiotic is sufficient for prophylaxis under most circumstances'. Clearly, in some instances prescribing falls outside of the guidelines. It is hoped that short period audits with stakeholder feedback will reduce the number of patients receiving unnecessarily prolonged prophylaxis, and steer prescribers away from cephalosporin use. The PPS is being repeated in November 2009, and comparisons will be presented highlighting differences between the 2008 & 2009 PPS results.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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