Onorato Lorenzo, Macera Margherita, Curatolo Caterina, Pattapola Viraj, Zollo Verdiana, Monari Caterina, Calò Federica, Di Girolamo Faraone Pasquale, Russo Ferdinando, Coppola Nicola
Infectious Diseases Section, Department of Mental Health and Public Medicine, University of Campania "L. Vanvitelli", Naples, Italy.
Infectious Disease Unit, A.O.U. "L. Vanvitelli", Naples, Italy.
J Glob Antimicrob Resist. 2024 Dec;39:122-127. doi: 10.1016/j.jgar.2024.09.003. Epub 2024 Sep 13.
The aim of our study was to evaluate the rate of compliance to institutional guidelines on surgical antimicrobial prophylaxis (SAP) among the surgical wards of our facility and to evaluate the impact of our antimicrobial stewardship programme (ASP) on the adherence rate.
We conducted a cross-sectional study including all 14 surgical wards of our hospital. Eight of these wards participate in a non-restrictive ASP. All patients admitted to one of the wards who had been prescribed SAP were included; the appropriateness of prophylaxis was defined according to the institutional protocols.
During the study period, we evaluated 169 patients undergoing a surgical procedure, of whom 105 (62.1%) received SAP. Overall, 10 (10.5%) patients were prescribed unnecessary prophylaxis; among the remaining 95, 30 (31.6%) received appropriate prophylaxis, while 65 (68.4%) were prescribed SAP deemed inappropriate for one or more reasons (38.5% received a drug with a larger spectrum of activity, 9.2% a molecule with a narrower spectrum, 36.9% an incorrect dose and 76.9% a longer duration of prophylaxis). A higher number of patients in the inappropriate prophylaxis group received abdominal surgery (P = 0.001) and were admitted to a ward not participating in the ASP (P < 0.001). At multivariate analysis, being admitted to an ASP unit was the only factor independently related to having received appropriate prophylaxis.
A low rate of adherence to local guidelines on SAP was observed, but a non-restrictive ASP can significantly impact the appropriateness of surgical prophylaxis.
我们研究的目的是评估我院外科病房对手术抗菌药物预防（SAP）机构指南的依从率，并评估抗菌药物管理计划（ASP）对依从率的影响。
我们进行了一项横断面研究，纳入了我院所有14个外科病房。其中8个病房参与了非限制性的ASP。所有入住这些病房且被开具SAP的患者均被纳入；预防用药的合理性根据机构方案确定。
在研究期间，我们评估了169例接受外科手术的患者，其中105例（62.1%）接受了SAP。总体而言，10例（10.5%）患者被开具了不必要的预防用药；在其余95例中，30例（31.6%）接受了适当的预防用药，而65例（68.4%）被开具的SAP因一个或多个原因被认为不适当（38.5%接受了抗菌谱更广的药物，9.2%接受了抗菌谱更窄的药物，36.9%剂量不正确，76.9%预防用药持续时间过长）。不适当预防用药组中接受腹部手术的患者数量更多（P = 0.001），且入住未参与ASP的病房（P < 0.001）。多因素分析显示，入住ASP病房是唯一与接受适当预防用药独立相关的因素。
观察到对当地SAP指南的依从率较低，但非限制性的ASP可显著影响手术预防用药的合理性。
