Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.
Department of Orthopaedics, Northern Health, Epping, VIC, Australia.
BMC Surg. 2021 Nov 23;21(1):404. doi: 10.1186/s12893-021-01398-7.
Open reduction internal fixation (ORIF) of closed fractures is a required indication for surgical antimicrobial prophylaxis (SAP). Guidelines contain recommendations on how best to prescribe SAP, however, adherence to SAP guidelines remains suboptimal. The Australian Therapeutic Guidelines: Antibiotic v16 (updated April 2019) advocates for single dose prophylaxis for ORIF procedures. There is a paucity of information on how SAP is prescribed for ORIF of closed fractures in Australian hospitals. The aim of this study was to identify prescribing practice and to evaluate guideline adherence pre- and post-guideline update.
A retrospective audit was conducted for patients undergoing an ORIF of closed fractures at a metropolitan teaching hospital in a 6-month period during 2018 (pre-guideline update) and 2019 (post-guideline update). Data were collected on prescribing practice (perioperative antibiotics prescribed, dose, time and route of administration and duration of prophylaxis) and compared to SAP recommendations in Therapeutic Guidelines: Antibiotic v15 (2018) and v16 (2019). Descriptive statistics and Chi square tests were used to report categorical variables. Binary logistic regression was used to identify factors associated with guideline adherence. A p-value < 0.05 was deemed statistically significant.
Data were collected for a total of 390 patients (n = 185, 2018; n = 205, 2019). Cefazolin was the most commonly prescribed antibiotic as per guideline recommendations, with variable, yet appropriate doses observed across the two audit periods. While 78.3% of patients received SAP for the correct duration in 2018, only 20.4% of patients received single dose prophylaxis in 2019. Overall adherence to guidelines was 63.2% in the 2018, and 18.0% in the 2019 audit periods respectively. Patient age was significantly associated with an increase in overall guideline adherence, while lower limb fractures, an American Society of Anesthesiologists (ASA) score of 3 and emergency admissions were associated with decreased overall adherence to SAP guidelines.
Adherence to guidelines was greater with v15 (2018) compared with v16 (2019). Patient factors, including limb fracture site and ASA score, had little impact on guideline adherence. Further research is required to understand what influences guideline adherence in the orthopaedic setting.
闭合骨折的切开复位内固定（ORIF）是手术抗菌预防（SAP）的必要指征。指南包含了关于如何最佳开具 SAP 处方的建议，然而，SAP 指南的遵循情况仍不理想。澳大利亚治疗指南：抗生素 v16（2019 年 4 月更新）主张对 ORIF 手术进行单剂量预防。关于澳大利亚医院如何为闭合性骨折的 ORIF 开具 SAP 处方的信息很少。本研究的目的是确定开具处方的做法，并在指南更新前后评估指南的遵循情况。
对一家大都市教学医院在 2018 年（指南更新前）和 2019 年（指南更新后）的 6 个月内接受闭合性骨折 ORIF 治疗的患者进行回顾性审核。收集了关于处方实践（围手术期抗生素的开具、剂量、时间和给药途径以及预防时间）的数据，并与治疗指南：抗生素 v15（2018 年）和 v16（2019 年）中的 SAP 建议进行比较。使用描述性统计和卡方检验报告分类变量。使用二项逻辑回归确定与指南遵循相关的因素。p 值<0.05 被认为具有统计学意义。
共收集了 390 名患者的数据（n=185，2018 年；n=205，2019 年）。头孢唑林是最常按照指南建议开具的抗生素，在两个审核期间观察到剂量不同，但均为适当剂量。虽然 2018 年 78.3%的患者接受了正确持续时间的 SAP，但 2019 年只有 20.4%的患者接受了单剂量预防。2018 年和 2019 年审核期间，总体指南遵循率分别为 63.2%和 18.0%。患者年龄与总体指南遵循率显著相关，而下肢骨折、美国麻醉医师协会（ASA）评分 3 分和急诊入院与 SAP 指南总体遵循率降低相关。
与 v16（2019 年）相比，v15（2018 年）的指南遵循率更高。患者因素，包括肢体骨折部位和 ASA 评分，对指南的遵循影响不大。需要进一步研究以了解哪些因素影响矫形科的指南遵循。
