Appropriateness of surgical antimicrobial prophylaxis in Japanese university hospitals.

Humans Antibiotic Prophylaxis Retrospective Studies Hospitals, University Japan Guideline Adherence Anti-Bacterial Agents / therapeutic use Surgical Wound Infection / epidemiology Anti-Infective Agents / therapeutic use
Antimicrobial stewardship Japan Surgical antimicrobial prophylaxis Surgical site infection

Journal

The Journal of hospital infection
ISSN: 1532-2939
Titre abrégé: J Hosp Infect
Pays: England
ID NLM: 8007166

Informations de publication

Date de publication:
Nov 2022
Historique:
received: 07 05 2022
revised: 15 06 2022
accepted: 15 06 2022
pubmed: 15 7 2022
medline: 27 10 2022
entrez: 14 7 2022
Statut: ppublish

Résumé

Surgical antimicrobial prophylaxis (SAP) is one of the major purposes of antimicrobial use. To determine the adherence to the Japanese SAP guidelines in Japanese university hospitals. This was a retrospective cohort study including 15 general hospitals and one dental university hospital. Up to three cases of 18 designated surgeries were evaluated regarding adherence to Japanese SAP guidelines: selection of antibiotics, timing of administration, re-dosing intervals, and duration of SAP. When all items were appropriate, surgery was defined as 'appropriate'. In total, 688 cases (22-45 cases per surgery) were included. The overall appropriateness was 46.8% (322/688), and the appropriateness of each surgery ranged from 8.0% (2/25, cardiac implantable electronic device implantation) to 92.1% (35/38, distal gastrectomy). The appropriateness of each item was as follows: pre/intraoperative selections, 78.5% (540/688); timing of administrations, 96.0% (630/656); re-dosing intervals, 91.6% (601/656); postoperative selection, 78.9% (543/688); and duration of SAP, 61.4% (423/688). The overall appropriateness of hospitals ranged from 17.6% (9/51) to 73.3% (33/45). The common reasons for inappropriateness were the longer duration (38.5%, 265/688) and choice of antibiotics with a non-optimal antimicrobial spectrum before/during, and after surgery (19.0%, 131/688 and 16.9%, 116/688, respectively), compared to the guideline. Adherence to the guidelines differed greatly between the surgeries and hospitals. Large-scale multi-centre surveillance of SAP in Japanese hospitals is necessary to identify inappropriate surgeries, factors related to the appropriateness, and incidences of surgical site infections.

Sections du résumé

BACKGROUND BACKGROUND
Surgical antimicrobial prophylaxis (SAP) is one of the major purposes of antimicrobial use.
AIM OBJECTIVE
To determine the adherence to the Japanese SAP guidelines in Japanese university hospitals.
METHODS METHODS
This was a retrospective cohort study including 15 general hospitals and one dental university hospital. Up to three cases of 18 designated surgeries were evaluated regarding adherence to Japanese SAP guidelines: selection of antibiotics, timing of administration, re-dosing intervals, and duration of SAP. When all items were appropriate, surgery was defined as 'appropriate'.
FINDINGS RESULTS
In total, 688 cases (22-45 cases per surgery) were included. The overall appropriateness was 46.8% (322/688), and the appropriateness of each surgery ranged from 8.0% (2/25, cardiac implantable electronic device implantation) to 92.1% (35/38, distal gastrectomy). The appropriateness of each item was as follows: pre/intraoperative selections, 78.5% (540/688); timing of administrations, 96.0% (630/656); re-dosing intervals, 91.6% (601/656); postoperative selection, 78.9% (543/688); and duration of SAP, 61.4% (423/688). The overall appropriateness of hospitals ranged from 17.6% (9/51) to 73.3% (33/45). The common reasons for inappropriateness were the longer duration (38.5%, 265/688) and choice of antibiotics with a non-optimal antimicrobial spectrum before/during, and after surgery (19.0%, 131/688 and 16.9%, 116/688, respectively), compared to the guideline.
CONCLUSIONS CONCLUSIONS
Adherence to the guidelines differed greatly between the surgeries and hospitals. Large-scale multi-centre surveillance of SAP in Japanese hospitals is necessary to identify inappropriate surgeries, factors related to the appropriateness, and incidences of surgical site infections.

Identifiants

DOI: 10.1016/j.jhin.2022.06.017 PMID: 35835283
pubmed: 35835283
pii: S0195-6701(22)00218-3
doi: 10.1016/j.jhin.2022.06.017
pii:
doi:

Substances chimiques

Anti-Bacterial Agents 0
Anti-Infective Agents 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

189-197

Informations de copyright

Copyright © 2022 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Auteurs

H Morioka (H)

Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan. Electronic address: morioka-hiroshi@med.nagoya-u.ac.jp.

H Ohge (H)

Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan.

M Nagao (M)

Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.

H Kato (H)

Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan.

R Kokado (R)

Division of Infection Control and Prevention, Osaka University Hospital, Suita, Japan.

K Yamada (K)

Department of Infection Control Science, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.

T Yamada (T)

Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, Japan.

N Shimono (N)

Center for the Study of Global Infection, Kyushu University Hospital, Fukuoka, Japan.

Y Nukui (Y)

Department of Infection Control and Prevention, Tokyo Medical and Dental University Hospital, Tokyo, Japan; Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.

S Yoshihara (S)

Center for Infectious Diseases, Nara Medical University, Kashihara, Japan.

I Sakamaki (I)

Department of Clinical Infectious Diseases, Toyama University Hospital, Toyama, Japan.

K Nosaka (K)

Department of Hematology, Rheumatology and Infectious Disease, Kumamoto University Hospital, Kumamoto, Japan.

Y Kubo (Y)

Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, Japan.

H Kawamura (H)

Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan.

Y Fujikura (Y)

Department of Medical Risk Management and Infection Control, National Defense Medical College Hospital, Tokorozawa, Japan.

T Kitaura (T)

Division of Infectious Diseases, Tottori University Hospital, Yonago, Japan.

M Sunakawa (M)

Dental Hospital, Infection Control Team, Tokyo Medical and Dental University, Tokyo, Japan.

T Yagi (T)

Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Appropriateness of surgical antimicrobial...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Prémédication › Antibioprophylaxie › Appropriateness of surgical antimicrobial...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Appropriateness of surgical antimicrobial...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Hôpitaux › Hôpitaux d'enseignement › Hôpitaux universitaires › Appropriateness of surgical antimicrobial...
questionsmedicales.fr › Régions géographiques › Iles › Japon › Appropriateness of surgical antimicrobial...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Adhésion aux directives › Appropriateness of surgical antimicrobial...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Appropriateness of surgical antimicrobial...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Infection de plaie opératoire › Appropriateness of surgical antimicrobial...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Appropriateness of surgical antimicrobial...