11 Nov 2019
Over half of antibiotics given after surgery prescribed inappropriately
Melbourne researchers have found over half of antibiotics given after surgery to prevent infection is given inappropriately, such as an incorrect dose or duration, and didn’t keep within recommended prescribing guidelines.
Surgical antibiotic prophylaxis (SAP) is the most common reason for prescribing antibiotics in Australian hospitals.
Research led by University of Melbourne PhD student Courtney Ierano from the National Centre for Antimicrobial Stewardship (NCAS) at the Doherty Institute looked at SAP prescriptions from the Surgical National Antimicrobial Prescribing Survey (Surgical NAPS) from 2016 to 2018.
Surgical NAPS was developed to gain further insight into SAP prescribing practices and identify potential targets for quality improvement. The overall rate of SAP prescribing appropriateness was low (48.7% of 15,395 prescriptions).
“SAP is prescribed poorly both before and after surgery and across all included surgical specialties. There’s a perception that antibiotics are needed for a certain length of time after the procedure to prevent infection,” Ms Ierano said.
“For the majority of surgical procedures, antibiotics and not required following the end of the surgery. Prolonged use of antibiotics has the potential to cause direct harm to patients through side effects, allergies, microbiome changes and toxicity.
“It may also contribute to the patient becoming colonised or infected with antibiotic resistant bacteria, one of the biggest global public health threats of our time.”
The study found when adjusting for hospital type, patient and surgical factors, the adjusted range of appropriateness for SAP prescribing was low for all audited surgical specialties, across both procedural (33.7-68%) and post-procedural (21.5-58.7%) prescribing.
The most common reason for deviating from the recommended prescribing guidelines for procedural prescribing was incorrect timing (44.9%), whilst incorrect duration (54.3%) was the most common reason for post-procedural prescribing. We note that the choice of antibiotic was not a common reason for inappropriate prescribing.
Director of Clinical Operations for the Guidance Group at Melbourne Health Dr Rodney James said Surgical NAPS examines various aspects of SAP prescribing.
“The aim of the Surgical NAPS is to provide detailed information regarding SAP to help surgeons, pharmacists and nurses understand which aspects of prescribing, such as antimicrobial choice, timing, dose or duration, can be improved,” Dr James said
“We also acknowledge that antibiotic overuse is not just a surgical problem, but a societal problem that requires a 'one health' approach. Therefore, the Guidance Group in collaboration with the National Centre for Antimicrobial Stewardship are constantly developing new auditing tools to help understand the reasons for inappropriate prescribing in all healthcare settings.”
Ms Ierano said there is much room for improvement in data collection practices.
“There is a need to collect other data to support changes in prescribing behaviour,” she said
The Surgical National Antimicrobial Prescribing Survey was developed and is provided by the National Centre for Antimicrobial Stewardship (University of Melbourne) and the Guidance Group (Melbourne Health). Both are based at the Peter Doherty Institute for Infection and Immunity (a joint venture between the University of Melbourne and the Royal Melbourne Hospital). The Surgical NAPS is supported by the Commonwealth Department of Health and the Australian Commission on Safety and Quality in Health Care as part of the Antimicrobial Use and Resistance in Australia program.