Evaluation of Antibiotic Prophylaxis Regimens in Gynecological Surgeries in a Referral Teaching Hospital: A Cross Sectional Study
Abstract
Background: Drug utilization Evaluation is the main tool to assess the clinical and economic effects of drug on health-care system. The aim of the current study is to evaluate the regimens of antibiotic prophylaxis in common gynecological surgeries in a referral teaching hospital Methods: This cross-sectional study was done in Alzahra hospital, Tabriz, Iran, from July 2017 to December 2017. Patients who received antibiotics as surgical site infection prophylaxis were enrolled. Data were collected from patients’ medical records and adherence rate to the American Society of Health-System Pharmacists (ASHP) guideline was studied as the primary endpoint. Results: A total of 210 patients who undergoes common gynecological surgeries were evaluated. Cesarean section (58.6%) and total abdominal hysterectomy (28.1%) were the majority of surgeries. The type of administered antibiotic was adherent to guideline in 71.4%. Doses and duration of prescribed antibiotic (Cefazolin, the most prescribed antibiotic) were not in accordance with the guideline in 100%. Only in 58%, the time of antibiotic administration was corrected. Conclusion: In this study, the misuse of antibiotics in most cases was documented in terms of type, dose and duration of drug administration in Al-Zahra Hospital. It seems necessary to publish evidence-based guidelines and monitor their proper implementation, not only to reduce costs but also to combat antibiotic resistance.
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2. Shapiro M, Townsend TR, Rosner B, Kass EH. Use of antimicrobial drugs in general hospitals: patterns of prophylaxis. New Engl J Med 1979;301:351-5.
3. Holloway K, Green T. Tools to investigate the use of medicines. Drug and therapeutics committees: A practical guide. World Health Organization (WHO) 2003.
4. Stolar MH. Conceptual framework for drug usage review, medical audit and other patient care review procedures. Am J Health-Syst Pharm 1977;34:139-45.
5. Chelmow D, Marder AL, Boggess KA. Should patients undergoing low-risk C/S receive antibiotic prophylaxis? Contemporary OB/GYN 2006;51:57-62.
6. Jamie W, Duff P. Preventing infections during elective C/S and abdominal hysterectomy.(C/S Hysterectomy Infections). Contemporary OB/GYN 2003;48:60-6.
7. Vukomanovic P, Stefanovic M, Kutlesic R, Milosevic J, Golubovic Z, Stojiljkovic P. Antibiotic prophylaxis single center experience. Acta Facul Med Naiss 2008;25:61-7.
8. Duff P. Prophylactic antibiotics for hysterectomy. Protocol for infectious disease in obstetrics and gynecology, 2nd edn Malden, MA: Blackwell Science 2000:476-81.
9. Tajbakhsh S, Esfahani MN, Emaneini M, Motamed N, Rahmani E, Gharibi S. Identification of Streptococcus agalactiae by fluorescent in situ hybridization compared to culturing and the determination of prevalence of Streptococcus agalactiae colonization among pregnant women in Bushehr, Iran. BMC Infect Dis 2013;13:420.
10. Ahmadi S, Rahmani E, Ahmadi K, Bahreman B. Comparison of single dose of cefazolion versus single dose of cefazolin plus seven days cephalexin prophylactic therapy in postoperative infections after elective cesarean section and immediate adverse effect of antibiotic on infants. Iran J Obstet Gynecol Infertil 2016;19:1-7.
11. Chen S, Chen JW, Guo B, Xu CC. Preoperative antisepsis with chlorhexidine versus povidone-iodine for the prevention of surgical site infection: A systematic review and meta-analysis. World J Surg 2020;44:1412-24.
12. Shackelford DP, Hoffman M, Davies M, Kaminski P. Predictive value for infection of febrile morbidity after vaginal surgery. Obstet Gynecol 1999;93:928-31.
13. Gottrup F, Melling A, Hollander DA. An overview of surgical site infections: aetiology, incidence and risk factors. EWMA J 2005;5:11-5.
14. Fukatsu K, Saito H, Matsuda T, Ikeda S, Furukawa S, Muto T. Influences of type and duration of antimicrobial prophylaxis on an outbreak of methicillin-resistant Staphylococcus aureus and on the incidence of wound infection. Arch Surg 1997;132:1320-5.
15. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. ASHP Commission on Therapeutics. Clin Pharm 1992;11:483-513.
16. Antibiotic prophylaxis in surgery: summary of a Swedish-Norwegian Consensus Conference. Scand J Infect Dis 1998;30:547-57.
17. Martin C. Antimicrobial prophylaxis in surgery: general concepts and clinical guidelines. French Study Group on Antimicrobial Prophylaxis in Surgery, French Society of Anesthesia and Intensive Care. Infect Control Hosp Epidemiol 1994;15:463-71.
18. Woods RK, Dellinger EP. Current guidelines for antibiotic prophylaxis of surgical wounds. Am Fam Physician 1998;57:2731-40.
19. Dellinger EP, Hausmann SM, Bratzler DW, et al. Hospitals collaborate to decrease surgical site infections. Am J Surg 2005;190:9-15.
20. 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(11):741-8.
21. Rehan HS, Kakkar AK, Goel S. Pattern of surgical antibiotic prophylaxis in a tertiary care teaching hospital in India. Int J Infect Control 2010;6(2): https://doi.org/10.3396/ijic.v6i2.4584.
22. Van Kasteren M, Kullberg BJ, De Boer A, Mintjes-de Groot J, Gyssens I. Adherence to local hospital guidelines for surgical antimicrobial prophylaxis: a multicentre audit in Dutch hospitals. J Antimicrob Chemother 2003;51:1389-96.
23. Ram VGR, VidyaSagar R, Krishnan GG, Senthivelan M. Surgical antibiotic prophylaxis in a tertiary care teaching hospital in India. World J Pharm Pharm Sci 2014;3:968-76.
24, Meakins J, Masterson B. Prevention of postoperative infection. ACS Surgery: Principles and Practice. BC Decker Inc, hal 2008;1:6-7.
25. Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. New Engl J Med 1992;326:281-6.
26. Stone HH, Hooper C, Kolb LD, Geheber CE, Dawkins EJ. Antibiotic prophylaxis in gastric, biliary and colonic surgery. Ann Surg 1976;184:443.
27. Hussain MI, Alam MK, Al-Qahatani HH, Al-Akeely MH. Role of postoperative antibiotics after appendectomy in non-perforated appendicitis. J Coll Physicians Surg Pak 2012;22:756-9.
28. Mottini M, Wolf R, Soong PL, Lieger O, Nakahara K, Schaller B. The role of postoperative antibiotics in facial fractures: comparing the efficacy of a 1-day versus a prolonged regimen. J Trauma Acute Care Surg 2014;76:720-4.
29 Rafiq MS, Khan MM, Khan A, Jan H. Evaluation of postoperative antibiotics after non-perforated appendectomy. J Pak Med Assoc 2015;65:815-7.
30. Hecker MT, Aron DC, Patel NP, Lehmann MK, Donskey CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163:972-8.
31. Kernodle DS, Barg NL, Kaiser AB. Low-level colonization of hospitalized patients with methicillin-resistant coagulase-negative staphylococci and emergence of the organisms during surgical antimicrobial prophylaxis. Antimicrob Agents Chemother 1988;32:202-8.
32. Takesue Y, Yokoyama T, Akagi S, Ohge H, Imamura Y, Murakami Y, et al. Changes in the intestinal flora after the administration of prophylactic antibiotics to patients undergoing a gastrectomy. Surg Today 2002;32:581-6.
2. Shapiro M, Townsend TR, Rosner B, Kass EH. Use of antimicrobial drugs in general hospitals: patterns of prophylaxis. New Engl J Med 1979;301:351-5.
3. Holloway K, Green T. Tools to investigate the use of medicines. Drug and therapeutics committees: A practical guide. World Health Organization (WHO) 2003.
4. Stolar MH. Conceptual framework for drug usage review, medical audit and other patient care review procedures. Am J Health-Syst Pharm 1977;34:139-45.
5. Chelmow D, Marder AL, Boggess KA. Should patients undergoing low-risk C/S receive antibiotic prophylaxis? Contemporary OB/GYN 2006;51:57-62.
6. Jamie W, Duff P. Preventing infections during elective C/S and abdominal hysterectomy.(C/S Hysterectomy Infections). Contemporary OB/GYN 2003;48:60-6.
7. Vukomanovic P, Stefanovic M, Kutlesic R, Milosevic J, Golubovic Z, Stojiljkovic P. Antibiotic prophylaxis single center experience. Acta Facul Med Naiss 2008;25:61-7.
8. Duff P. Prophylactic antibiotics for hysterectomy. Protocol for infectious disease in obstetrics and gynecology, 2nd edn Malden, MA: Blackwell Science 2000:476-81.
9. Tajbakhsh S, Esfahani MN, Emaneini M, Motamed N, Rahmani E, Gharibi S. Identification of Streptococcus agalactiae by fluorescent in situ hybridization compared to culturing and the determination of prevalence of Streptococcus agalactiae colonization among pregnant women in Bushehr, Iran. BMC Infect Dis 2013;13:420.
10. Ahmadi S, Rahmani E, Ahmadi K, Bahreman B. Comparison of single dose of cefazolion versus single dose of cefazolin plus seven days cephalexin prophylactic therapy in postoperative infections after elective cesarean section and immediate adverse effect of antibiotic on infants. Iran J Obstet Gynecol Infertil 2016;19:1-7.
11. Chen S, Chen JW, Guo B, Xu CC. Preoperative antisepsis with chlorhexidine versus povidone-iodine for the prevention of surgical site infection: A systematic review and meta-analysis. World J Surg 2020;44:1412-24.
12. Shackelford DP, Hoffman M, Davies M, Kaminski P. Predictive value for infection of febrile morbidity after vaginal surgery. Obstet Gynecol 1999;93:928-31.
13. Gottrup F, Melling A, Hollander DA. An overview of surgical site infections: aetiology, incidence and risk factors. EWMA J 2005;5:11-5.
14. Fukatsu K, Saito H, Matsuda T, Ikeda S, Furukawa S, Muto T. Influences of type and duration of antimicrobial prophylaxis on an outbreak of methicillin-resistant Staphylococcus aureus and on the incidence of wound infection. Arch Surg 1997;132:1320-5.
15. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. ASHP Commission on Therapeutics. Clin Pharm 1992;11:483-513.
16. Antibiotic prophylaxis in surgery: summary of a Swedish-Norwegian Consensus Conference. Scand J Infect Dis 1998;30:547-57.
17. Martin C. Antimicrobial prophylaxis in surgery: general concepts and clinical guidelines. French Study Group on Antimicrobial Prophylaxis in Surgery, French Society of Anesthesia and Intensive Care. Infect Control Hosp Epidemiol 1994;15:463-71.
18. Woods RK, Dellinger EP. Current guidelines for antibiotic prophylaxis of surgical wounds. Am Fam Physician 1998;57:2731-40.
19. Dellinger EP, Hausmann SM, Bratzler DW, et al. Hospitals collaborate to decrease surgical site infections. Am J Surg 2005;190:9-15.
20. 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(11):741-8.
21. Rehan HS, Kakkar AK, Goel S. Pattern of surgical antibiotic prophylaxis in a tertiary care teaching hospital in India. Int J Infect Control 2010;6(2): https://doi.org/10.3396/ijic.v6i2.4584.
22. Van Kasteren M, Kullberg BJ, De Boer A, Mintjes-de Groot J, Gyssens I. Adherence to local hospital guidelines for surgical antimicrobial prophylaxis: a multicentre audit in Dutch hospitals. J Antimicrob Chemother 2003;51:1389-96.
23. Ram VGR, VidyaSagar R, Krishnan GG, Senthivelan M. Surgical antibiotic prophylaxis in a tertiary care teaching hospital in India. World J Pharm Pharm Sci 2014;3:968-76.
24, Meakins J, Masterson B. Prevention of postoperative infection. ACS Surgery: Principles and Practice. BC Decker Inc, hal 2008;1:6-7.
25. Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. New Engl J Med 1992;326:281-6.
26. Stone HH, Hooper C, Kolb LD, Geheber CE, Dawkins EJ. Antibiotic prophylaxis in gastric, biliary and colonic surgery. Ann Surg 1976;184:443.
27. Hussain MI, Alam MK, Al-Qahatani HH, Al-Akeely MH. Role of postoperative antibiotics after appendectomy in non-perforated appendicitis. J Coll Physicians Surg Pak 2012;22:756-9.
28. Mottini M, Wolf R, Soong PL, Lieger O, Nakahara K, Schaller B. The role of postoperative antibiotics in facial fractures: comparing the efficacy of a 1-day versus a prolonged regimen. J Trauma Acute Care Surg 2014;76:720-4.
29 Rafiq MS, Khan MM, Khan A, Jan H. Evaluation of postoperative antibiotics after non-perforated appendectomy. J Pak Med Assoc 2015;65:815-7.
30. Hecker MT, Aron DC, Patel NP, Lehmann MK, Donskey CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163:972-8.
31. Kernodle DS, Barg NL, Kaiser AB. Low-level colonization of hospitalized patients with methicillin-resistant coagulase-negative staphylococci and emergence of the organisms during surgical antimicrobial prophylaxis. Antimicrob Agents Chemother 1988;32:202-8.
32. Takesue Y, Yokoyama T, Akagi S, Ohge H, Imamura Y, Murakami Y, et al. Changes in the intestinal flora after the administration of prophylactic antibiotics to patients undergoing a gastrectomy. Surg Today 2002;32:581-6.
| Files | ||
| Issue | Vol 9, No 4 (Autumn 2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v9i4.8224 | |
| Keywords | ||
| Drug Utilization Antibiotic Gynecological Surgeries | ||
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How to Cite
1.
Naeimzadeh F, Bastani P, Shaseb E. Evaluation of Antibiotic Prophylaxis Regimens in Gynecological Surgeries in a Referral Teaching Hospital: A Cross Sectional Study. J Pharm Care. 2021;9(4):190-194.
