Antimicrobial prophylaxis in surgery in Belgian hospitals: room for improvement.

OBJECTIVE

To evaluate the current practice of surgical antimicrobial prophylaxis in Belgium.

DESIGN

Prospective multicentre incidence study.

SETTING

58 of the 206 acute hospitals in Belgium.

SUBJECTS

19746 patients who had operations between October 1992 and June 1993, with detailed analysis of 7983 procedures for which the antimicrobial regimens were known.

RESULTS

Antibiotic prophylaxis was given before 14099 (71%) of the 19746 operations. It was given in 57% of the procedures for which prophylaxis is generally not recommended, but it was not used in 14% of procedures for which it is generally recommended, nor in 14% of all contaminated procedures. Duration of operation superseded degree of wound contamination, ASA (American Society of Anesthesiologists) score, and degree of urgency as a predictor of the use of prophylaxis. Prophylaxis was prolonged by more than 2 days postoperatively after 23% of the procedures and by more than 4 days in 8%. Five types of regimens accounted for 80% of all prophylaxis, but overall 234 different regimens were prescribed. Large differences were found in hospital university affiliation status. In general, trends were favourable compared with a study in 1986.

CONCLUSION

Although there was improvement compared with 1986, antimicrobial prophylaxis in surgery could still be more appropriate in terms of indication, duration, and rational choice of drugs.