Assessment of perioperative antibiotic prophylaxis for gynecological surgeries at an academic hospital in Brazil

Authors

DOI:

https://doi.org/10.33448/rsd-v10i8.17299

Keywords:

Antibiotic prophylaxis; Gynecologic surgical procedures; Practice patterns, physicians'.

Abstract

The aim of this study was to assess the adequacy of physicians' practice patterns regarding the use of perioperative antibiotic prophylaxis for gynecological surgeries in an academic hospital specialized in gynecology located at Rio de Janeiro city, Brazil. This is a retrospective study assessing all gynecological surgeries performed over one year. Appropriateness of antibiotic prophylaxis was determined according to criteria adapted from evidence-based guidelines. Clinical practice regarding the use of perioperative antibiotic prophylaxis was considered appropriate for 58.4% of 416 surgeries. The non-indicated use of antimicrobial prophylaxis was the main factor determining the low percentage of overall adequacy. Three variables were independently associated with inappropriate administration of perioperative antibiotics: patients age, breast surgeries and longer procedures. Antibiotic prophylaxis compliance to published recommendations is low. Women undergoing gynecological surgery are exposed to unnecessary risks associated to non-indicated use of antibiotic prophylaxis. Strategies aimed to improve compliance to evidence-based guidelines are necessary.

Author Biographies

Denise Ramos dos Santos, Federal University of Rio de Janeiro

Pharmacist at the Gynecology Institute of the Federal University of Rio de Janeiro, she is a specialist in Hospital Pharmacy from the Hospital Pharmacy Residency Program at the Fluminense Federal University and a Masters in Pharmaceutical Science and Technology from the Graduate Program in Pharmaceutical Science and Technology at FF/ UFRJ. It works in the areas of Pharmaceutical Assistance and Clinical Pharmacy.

Milene Rangel da Costa, Federal University of Rio de Janeiro

Associate Professor at the Faculty of Pharmacy of the Federal University of Rio de Janeiro, she has a Master's in Science in Biomedical Engineering from the Biomedical Engineering Program at COPPE/UFRJ and a Ph.D. in Biological Sciences/Biophysics from the Carlos Chagas Filho Biophysics Institute/UFRJ. He has a postdoctoral degree in Pharmacoeconomics at the Istituto di Ricerche Farmacologiche Mario Negri - Italy. He works in the areas of Health Technology Assessment, Health Economic Assessment and Applied Statistics.

 

References

Abubakar, U., Sulaiman, S. A., & Adesiyun, A. G. (2018). Utilization of surgical antibiotic prophylaxis for obstetrics and gynaecology surgeries in Northern Nigeria. Int J Clin Pharm, 40(5), 1037–1043. https://doi.org/10.1007/s11096-018-0702-0

Agência Nacional de Vigilância Sanitária. (2009). Sítio cirúrgico. Critérios nacionais de infecções relacionadas à assistência à saúde. Gerência Geral de Tecnologia em Serviços de Saúde, Gerência de Investigação e Prevenção das Infecções e dos Eventos Adversos. https://www.anvisa.gov.br/servicosaude/manuais/criterios_nacionais_isc.pdf

Agência Nacional de Vigilância Sanitária. (2017). Medidas de prevenção de infecção relacionada à assistência à saúde (2nd ed.). Gerência de Vigilância e Monitoramento em Serviços de Saúde, Gerência Geral de Tecnologia em Serviços de Saúde. http://www.riocomsaude.rj.gov.br/Publico/MostrarArquivo.aspx?C=pCiWUy84%2BR0%3

Alemkere, G. (2018). Antibiotic usage in surgical prophylaxis: A prospective observational study in the surgical ward of Nekemte referral hospital. PLoS One, 13(9), e0203523. https://doi.org/10.1371/journal.pone.0203523

Allegranzi, B., Nejad, S. B., Combescure, C., Graafmans, W., Attar, H., Donaldson, L., & Pittet, D. (2011). Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet, 377(9761), 228–241. https://doi.org/10.1016/S0140-6736(10)61458-4

American College of Obstetricians and Gynecologists. (2018). Prevention of infection after gynecologic procedures: ACOG practice bulletin, number 195. Obstet Gynecol, 131(6), e172–e189. https://doi.org/10.1097/AOG.0000000000002670

American Society of Breast Surgeons. (2017). Consensus Guideline on Preoperative Antibiotics and Surgical Site Infection in Breast Surgery. https://www.breastsurgeons.org/about/statements/PDF_Statements/Antibiotics_SurgicalSiteInfection.pdf

Bratzler, D. W., & Hunt, D. R. (2006). The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis, 43(3), 322–330. https://doi.org/10.1086/505220

Bratzler, D. W., Dellinger, E. P., Olsen, K. M., Perl, T. M., Auwaerter, P. G., Bolon, M. K., Fish, D. N., Napolitano, L. M., Sawyer, R. G., Slain, D., Steinberg, J. P., & Weinstein, R. A. (2013). Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt), 14(1), 73–156. https://doi.org/10.1089/sur.2013.9999

Brook, R. H. (2011). The role of physicians in controlling medical care costs and reducing waste. JAMA, 306(6), 650–651. https://doi.org/10.1001/jama.2011.1136

Burke, J. P. (2001). Maximizing appropriate antibiotic prophylaxis for surgical patients: an update from LDS Hospital, Salt Lake City. Clin Infect Dis, 33(s2), S78-S83. https://doi.org/10.1086/321861

Çakmakçi, M. (2015). Antibiotic stewardship programmes and the surgeon’s role. J Hosp Infect, 89(4), 264–266. https://doi.org/10.1016/j.jhin.2015.01.006

Clarke-Pearson, D. L., & Geller, E. J. (2013). Complications of hysterectomy. Obstet Gynecol, 121(3), 654–673. https://doi.org/10.1097/AOG.0b013e3182841594

Clifford, V., & Daley, A. (2012). Antibiotic prophylaxis in obstetric and gynaecological procedures: a review. Australian and New Zealand Journal of Obstetrics and Gynaecology, 52(5), 412–419. https://doi.org/10.1111/j.1479-828X.2012.01460.x

van Eyk, N., van Schalkwyk, J., & Infectious Diseases Committe. (2012). Antibiotic prophylaxis in gynaecologic procedures. J Obstet Gynaecol Can, 34(4), 382–391. https://doi.org/10.1016/S1701-2163(16)35222-7

Jaiyeoba, O. (2012). Postoperative infections in obstetrics and gynecology. Clinical Obstetrics and Gynecology, 55(4), 904–913. https://doi.org/10.1097/GRF.0b013e3182714734

Joyce, J. S., Langsjoen, J., Sharadin, C., Kuehl, T., & Larsen W. (2015). Non-Indicated Prophylactic Antibiotic use in Gynecologic Surgery. J Minim Invasive Gynecol, 22(3), S55–S56. https://doi.org/10.1016/j.jmig.2014.12.113

Kamat, A. A., Brancazio, L., & Gibson M. (2000). Wound infection in gynecologic surgery. Infect Dis Obstet Gynecol, 8(5-6), 230-234. https://doi.org/10.1155/S1064744900000338

van Kasteren, M. E. E., Kullberg, B. J., de Boer, A. S., Mintjes-de Groot, J., & Gyssens, I. C. (2003). Adherence to local hospital guidelines for surgical antimicrobial prophylaxis: a multicentre audit in Dutch hospitals. J Antimicrob Chemother, 51(6), 1389–1396. https://doi.org/10.1093/jac/dkg264

Kirkland, K. B., Briggs, J. P., Trivette, S. L., Wilkinson, W. E., & Sexton, D. J. (1999). The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol, 20(11), 725–730. https://doi.org/10.1086/501572

Kremer, K. M., Foster, R. T., Drobnis, E. Z., Hyde, K. J., & Brennaman L. M. (2018). Non-indicated use of prophylactic antibiotics in gynaecological surgery at an academic tertiary medical centre. J Obstet Gynaecol, 38(4), 1-5. https://doi.org/10.1080/01443615.2017.1371119

Leaper, D., Burman-Roy, S., Palanca, A., Cullen, K., Worster, D., Gautam-Aitken, E., & Whittle, M. (2008). Prevention and treatment of surgical site infection: summary of NICE guidance. BMJ, 337, a1924. https://doi.org/10.1136/bmj.a1924

Morrill, M. Y., Schimpf, M. O., Abed, H., Carberry, C., Margulies, R. U., White, A. B., Lowenstein, l., Ward, R. M., Balk, E. M., Uhlig, K., & Sung, V. W. (2013). Antibiotic prophylaxis for selected gynecologic surgeries. Int J Gynaecol Obstet, 120(1), 10–15. https://doi.org/10.1016/j.ijgo.2012.06.023

van Schalkwyk, J., van Eyk, N., & Infectious Diseases Committe. (2010). Antibiotic prophylaxis in obstetric procedures. J Obstet Gynaecol Can, 32(9), 878–884. https://doi.org/10.1016/S1701-2163(16)34662-X

Schimpf, M. O., Morrill, M. Y., Margulies, R. U., Ward, R. M., Carberry, C. L., & Sung, V. W. (2012). Surgeon practice patterns for antibiotic prophylaxis in gynecologic surgery. Female Pelvic Med Reconstr Surg, 18(5), 281–285. https://doi.org/10.1097/SPV.0b013e31826446ba

Stulberg, J. J., Delaney, C. P., Neuhauser, D. V., Aron, D. C., Fu, P., & Koroukian, S. M. (2010). Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA, 303(24), 2479–2485. https://doi.org/10.1001/jama.2010.841

Viamonte, R. K., & Cherres, J. P. E. (2016). Proflaxis antibiótica preoperatoria en pacientes con cirugías ginecológicas en el Hospital “Homero Castanier Crespo.” Rev Cubana Obstet Ginecol, 42(4), 543–556. http://scielo.sld.cu/pdf/gin/v42n4/gin15416.pdf

Wright, J. D., Hassan, K., Ananth, C. V., Herzog, T. J., Lewin, S. N., Burke, W. M., Lu, Y., Neugut, A. I., & Hershman, D. L. (2013). Use of guideline-based antibiotic prophylaxis in women undergoing gynecologic surgery. Obstet Gynecol, 122(6), 1145–1153. https://doi.org/10.1097/aog.0b013e3182a8a36a

World Health Organization. (‎2018)‎. Global guidelines for the prevention of surgical site infection (2nd ed.). World Health Organization. https://apps.who.int/iris/handle/10665/277399

World Health Organization Collaborating Centre for Drug Statistics Methodology. (2020). WHOCC - ATC/DDD Index. Whocc.no. https://www.whocc.no/atc_ddd_index/

Downloads

Published

13/07/2021

How to Cite

SANTOS, D. R. dos .; COSTA, M. R. da . Assessment of perioperative antibiotic prophylaxis for gynecological surgeries at an academic hospital in Brazil. Research, Society and Development, [S. l.], v. 10, n. 8, p. e30810817299, 2021. DOI: 10.33448/rsd-v10i8.17299. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/17299. Acesso em: 23 nov. 2024.

Issue

Vol. 10 No. 8

Section

Health Sciences

License

Copyright (c) 2021 Denise Ramos dos Santos; Milene Rangel da Costa

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.