AUDIT ON USE OF ANITIBIOTICS FOR SURGICAL PROPHYLAXIS

INTRODUCTION
 Surgical Antibiotic Prophylaxis reduces the likelihood of infection where:
 Inoculum of infecting bacteria likely to be high.
 Procedure may result in infection from small inoculum
 The idea behind prophylaxis is not to protect against post operatively acquired infection.
 In most cases single I.V dose at induction is adequate.
 The audit is based on evidence obtained from national and local guidelines and evidence based literature prepared by our micro department


OBJECTIVES
 To ascertain current practice in most surgical specialities.

 To find whether we use appropriate antibiotic.

 If so , appropriate dose or doses given at appropriate time.

 To come to a consensus among specialities regarding this and re-audit in 2 months time.


METHODS
 The audit was performed from 22nd of Feb – 15th of Mar.

 All surgical patients both elective and emergency were included.

 Totally 80 patients were followed up prospectively and data was obtained from anaesthetic and prescription charts.

 The pharmacist was also involved in obtaining data.


DATA INTERPRETATION

PERCENTAGE OF CASES IN EACH SPECIALITY
FINDINGS
PROPHYLAXIS GIVEN
DOSES GIVEN
(within appropriate prophylaxis GROUP)
NUMBER OF DOSES GIVEN
(within appropriate prophylaxis GROUP)
GIVEN AT APPROPRIATE TIME

(within appropriate prophylaxis GROUP)

OVERALL “INAPPROPRIATE” ANTIBIOTICS

“INAPPROPRIATE” ANTIBIOTICS WITHIN SPECIALITIES
REASON WHY“INAPPROPRIATE”

 Urology and General Surgery contributed the most towards the overall percentage of “inappropriate” use of antibiotics.

 However vascular and General Surgery contributed the most individually.

 Though the number of Orthopaedic cases that were followed up were high, 90% of cases received appropriate antibiotics.

 Most of the cases in Urology and General Surgery were “inappropriate” because the patients received treatment rather than prophylaxis.

 The patients who received “inappropriate” antibiotics underwent the following procedures:

 We also observed that each surgical consultant had their own choice of antibiotics which at times were “inappropriate”.

 This resulted in some of the anaesthetists giving “inappropriate” antibiotics as prophylaxis.


NO CURENT RECOMMENDATIONS

SUMMARY
 Based on the findings we observed that almost 60% of patients received appropriate antibiotic prophylaxis.

 Guidelines are not available for more than 20% of cases audited.

 Potential implications for the patient and the trust are to provide high level prophylaxis while minimising production of resistant microbes.

 We welcome evidence based suggestions from all the staff involved in use of antibiotics following which guidelines can be revised for better practice in future.