Herawati Fauna, Yulia Rika, Wiyono Heru, Massey Firdaus Kabiru, Muliani Nurlina, Kantono Kevin, Soemantri Diantha, Andrajati Retnosari
Department of Clinical and Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya, Surabaya 60293, Indonesia.
Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok 16424, Indonesia.
Pharmaceuticals (Basel). 2021 Oct 27;14(11):1088. doi: 10.3390/ph14111088.
Clean surgery without contamination does not require prophylactic antibiotics, but there are high-risk surgical procedures that may cause infection and/or involve vital organs such as the heart, brain, and lungs, and these indeed require the use of antibiotics. This study aimed to determine the quantity of antibiotic use based on the defined daily dose (DDD) per 100 bed days and the quality of antibiotic use based on the percentage of concordance with The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines (i.e., route of administration, time of administration, selection, dose, and duration). This includes the profiles of surgical site infection (SSI) in surgical patients from January through June 2019. The study subjects were 487 surgical patients from two hospitals who met the inclusion criteria. There were 322 patients out of 487 patients who had a clean surgical procedure. Ceftriaxone (J01DD04) was the most used antibiotic, with a total DDD/100 bed days value in hospitals A and B, respectively: pre-surgery: 14.71, 77.65, during surgery: 22.57, 87.31, and postsurgery: 38.34, 93.65. In addition, 35% of antibiotics were given more than 120 min before incision. The lowest concordance to ASHP therapeutic guideline in hospital A (17.6%) and B (1.9%) was antibiotic selection. Two patients experienced SSI with bacterial growths of spp., , , and . The usage of prophylactic antibiotics for surgical procedures was high and varied between hospitals. Hospital B had significantly lower concordance to antibiotic therapeutic guidelines, resulting to a higher infection rate, compared with hospital A. ASHP adherence components were then further investigated, after which antibiotic dosing interval and injection time was found to be a significant predictor for positive bacterial growth based on logit-logistic regression. Further interventions and strategies to implement antibiotic stewardship is needed to improve antibiotic prescriptions and their use.
无污染的清洁手术不需要预防性使用抗生素，但有些高风险手术可能会导致感染和/或涉及心脏、大脑和肺部等重要器官，这些手术确实需要使用抗生素。本研究旨在确定每100个床日基于限定日剂量（DDD）的抗生素使用量，以及基于与美国卫生系统药师协会（ASHP）治疗指南的符合率（即给药途径、给药时间、选择、剂量和持续时间）的抗生素使用质量。这包括2019年1月至6月手术患者的手术部位感染（SSI）情况。研究对象为来自两家医院的487例符合纳入标准的手术患者。487例患者中有322例接受了清洁手术。头孢曲松（J01DD04）是使用最多的抗生素，在A医院和B医院每100个床日的DDD总值分别为：术前：14.71、77.65，术中：22.57、87.31，术后：38.34、93.65。此外，35%的抗生素在切口前120分钟以上给药。A医院（17.6%）和B医院（1.9%）与ASHP治疗指南符合率最低的是抗生素选择。两名患者发生了手术部位感染，细菌培养结果为 spp.、 、 、 。手术预防性抗生素的使用量较高且各医院之间存在差异。与A医院相比，B医院与抗生素治疗指南的符合率显著较低，导致感染率较高。随后进一步研究了ASHP依从性的组成部分，经logit-逻辑回归分析发现，抗生素给药间隔和注射时间是细菌生长阳性的显著预测因素。需要进一步采取干预措施和策略来实施抗生素管理，以改善抗生素处方及其使用情况。
