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Twenty-six healthcare facilities (67% of the facilities in the region) volunteered to participate in the audit.
2303 files were evaluated.
Overall compliance with ABP guidelines was found in only 64% of the files evaluated, a result similar to the literature and to a 2008 study.
Injection timing (0–60 minutes before incision) is the most problematic indicator, as compliance was shown in only 77.6% of the files.
Elaboration of a regionwide action plan.
While regional monitoring of antibiotic use has decreased since 2011 by 3.2%, in some healthcare facilities a significant increase (+43%) has occurred. The purpose of this study was to assess regional antibiotic prophylaxis (ABP) compliance with national guidelines.
Material and methods
In 2015, 26 healthcare facilities, both public and private, were requested to audit five items: utilization of antibiotic prophylaxis, the antimicrobial agent (the molecule) administered, time between injection and incision, initial dose, number of intraoperative and postoperative additional doses. Seven surgical procedures were selected for assessment: appendicectomy (APP), cataract (CAT), cesarean section (CES), colorectal cancer surgery (CCR), hysterectomy (HYS), total hip arthroplasty (THA) and transurethral resection of the prostate (TURP). A statistical analysis of the 2303 records included was carried out.
The general rate of antibiotic prophylaxis compliance was 64%. The antimicrobial agent used and initial dose were in compliance with the guidelines for 93% and 97.4% of cases respectively, and administration of antibiotic prophylaxis was achieved 60minutes before incision in 77.6% of the records included. Regarding gastrointestinal surgery, amoxicillin/clavulanic acid was used in 32% of patients. In 26% of appendectomy files, administration occurred after incision, and one out of two files showed non-complaint perioperative and postoperative consumption.
Compliance with nationwide ABP guidelines is in need of pronounced improvement, especially with regard to time interval between injection and incision and the molecule prescribed. An action plan based on specific recommendations addressed to each establishment and an updated regionwide ABP protocol are aimed at achieving better and reduced consumption of antimicrobial agents.Le texte complet de cet article est disponible en PDF.
Keywords : Antibiotic prophylaxis/statistics & numerical data, Clinical audit, Guideline adherence, Surgical Wound/Surgical site Infection/prevention & control*
|☆|| Presentation in congresses: where do we stand with regard to surgical antibiotic prophylaxis (ABP)? Results of a regionwide study. Nicolas Prévosta, Aurélie Gaultierb, Julie Mocquarda, Cécile Loonisb, Gabriel Birgandc, Aurélie Marqueta, Jean-Claude Maupetita, Romain Dumontd. aOMEDIT Pays de la Loire; bRéseau Qualisanté; cAntenne régionale de lutte contre les infections nosocomiales (ARLIN) Pays de la Loire; dCHU de Nantes; congrès de la SFAR, septembre 2016, Paris, France. Évaluation régionale des pratiques d’antibioprophylaxie (ABP) chirurgicale/Regionwide evaluation of current practices in surgical antibiotic prophylaxis (ABP). F. d’Acremonta, J. Mocquarda, N. Prévosta, A. Marquetb, E. Batardb, E. Rochaisa, J-C. Maupetita. aUnité de coordination régionale, OMEDIT Pays de la Loire; bObservatoire des antibiotiques, OMEDIT Pays de la Loire; congrès Hopipharm, mai 2017, Nancy, France.