Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection

Clean surgery without contamination does not require prophylactic antibiotics, but there are high-risk surgical procedures that may cause infection and/or involve vital organs such as the heart, brain, and lungs, and these indeed require the use of antibiotics. This study aimed to determine the quan...

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Autores principales:	Fauna Herawati, Rika Yulia, Heru Wiyono, Firdaus Kabiru Massey, Nurlina Muliani, Kevin Kantono, Diantha Soemantri, Retnosari Andrajati
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	defined daily dose surgical site infection antibiotic stewardship hospital Medicine R Pharmacy and materia medica RS1-441
Acceso en línea:	https://doaj.org/article/57510d684f1048a6b1ee7bd0863955a6
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spelling	oai:doaj.org-article:57510d684f1048a6b1ee7bd0863955a62021-11-25T18:39:14ZDiscordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection10.3390/ph141110881424-8247https://doaj.org/article/57510d684f1048a6b1ee7bd0863955a62021-10-01T00:00:00Zhttps://www.mdpi.com/1424-8247/14/11/1088https://doaj.org/toc/1424-8247Clean surgery without contamination does not require prophylactic antibiotics, but there are high-risk surgical procedures that may cause infection and/or involve vital organs such as the heart, brain, and lungs, and these indeed require the use of antibiotics. This study aimed to determine the quantity of antibiotic use based on the defined daily dose (DDD) per 100 bed days and the quality of antibiotic use based on the percentage of concordance with The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines (i.e., route of administration, time of administration, selection, dose, and duration). This includes the profiles of surgical site infection (SSI) in surgical patients from January through June 2019. The study subjects were 487 surgical patients from two hospitals who met the inclusion criteria. There were 322 patients out of 487 patients who had a clean surgical procedure. Ceftriaxone (J01DD04) was the most used antibiotic, with a total DDD/100 bed days value in hospitals A and B, respectively: pre-surgery: 14.71, 77.65, during surgery: 22.57, 87.31, and postsurgery: 38.34, 93.65. In addition, 35% of antibiotics were given more than 120 min before incision. The lowest concordance to ASHP therapeutic guideline in hospital A (17.6%) and B (1.9%) was antibiotic selection. Two patients experienced SSI with bacterial growths of <i>Proteus</i> spp., <i>Staphylococcus aureus</i>, <i>Staphylococcus epidermidis</i>, and <i>Escherichia coli</i>. The usage of prophylactic antibiotics for surgical procedures was high and varied between hospitals. Hospital B had significantly lower concordance to antibiotic therapeutic guidelines, resulting to a higher infection rate, compared with hospital A. ASHP adherence components were then further investigated, after which antibiotic dosing interval and injection time was found to be a significant predictor for positive bacterial growth based on logit–logistic regression. Further interventions and strategies to implement antibiotic stewardship is needed to improve antibiotic prescriptions and their use.Fauna HerawatiRika YuliaHeru WiyonoFirdaus Kabiru MasseyNurlina MulianiKevin KantonoDiantha SoemantriRetnosari AndrajatiMDPI AGarticledefined daily dosesurgical site infectionantibiotic stewardshiphospitalMedicineRPharmacy and materia medicaRS1-441ENPharmaceuticals, Vol 14, Iss 1088, p 1088 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	defined daily dose surgical site infection antibiotic stewardship hospital Medicine R Pharmacy and materia medica RS1-441
spellingShingle	defined daily dose surgical site infection antibiotic stewardship hospital Medicine R Pharmacy and materia medica RS1-441 Fauna Herawati Rika Yulia Heru Wiyono Firdaus Kabiru Massey Nurlina Muliani Kevin Kantono Diantha Soemantri Retnosari Andrajati Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection
description	Clean surgery without contamination does not require prophylactic antibiotics, but there are high-risk surgical procedures that may cause infection and/or involve vital organs such as the heart, brain, and lungs, and these indeed require the use of antibiotics. This study aimed to determine the quantity of antibiotic use based on the defined daily dose (DDD) per 100 bed days and the quality of antibiotic use based on the percentage of concordance with The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines (i.e., route of administration, time of administration, selection, dose, and duration). This includes the profiles of surgical site infection (SSI) in surgical patients from January through June 2019. The study subjects were 487 surgical patients from two hospitals who met the inclusion criteria. There were 322 patients out of 487 patients who had a clean surgical procedure. Ceftriaxone (J01DD04) was the most used antibiotic, with a total DDD/100 bed days value in hospitals A and B, respectively: pre-surgery: 14.71, 77.65, during surgery: 22.57, 87.31, and postsurgery: 38.34, 93.65. In addition, 35% of antibiotics were given more than 120 min before incision. The lowest concordance to ASHP therapeutic guideline in hospital A (17.6%) and B (1.9%) was antibiotic selection. Two patients experienced SSI with bacterial growths of <i>Proteus</i> spp., <i>Staphylococcus aureus</i>, <i>Staphylococcus epidermidis</i>, and <i>Escherichia coli</i>. The usage of prophylactic antibiotics for surgical procedures was high and varied between hospitals. Hospital B had significantly lower concordance to antibiotic therapeutic guidelines, resulting to a higher infection rate, compared with hospital A. ASHP adherence components were then further investigated, after which antibiotic dosing interval and injection time was found to be a significant predictor for positive bacterial growth based on logit–logistic regression. Further interventions and strategies to implement antibiotic stewardship is needed to improve antibiotic prescriptions and their use.
format	article
author	Fauna Herawati Rika Yulia Heru Wiyono Firdaus Kabiru Massey Nurlina Muliani Kevin Kantono Diantha Soemantri Retnosari Andrajati
author_facet	Fauna Herawati Rika Yulia Heru Wiyono Firdaus Kabiru Massey Nurlina Muliani Kevin Kantono Diantha Soemantri Retnosari Andrajati
author_sort	Fauna Herawati
title	Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection
title_short	Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection
title_full	Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection
title_fullStr	Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection
title_full_unstemmed	Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection
title_sort	discordance to ashp therapeutic guidelines increases the risk of surgical site infection
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/57510d684f1048a6b1ee7bd0863955a6
work_keys_str_mv	AT faunaherawati discordancetoashptherapeuticguidelinesincreasestheriskofsurgicalsiteinfection AT rikayulia discordancetoashptherapeuticguidelinesincreasestheriskofsurgicalsiteinfection AT heruwiyono discordancetoashptherapeuticguidelinesincreasestheriskofsurgicalsiteinfection AT firdauskabirumassey discordancetoashptherapeuticguidelinesincreasestheriskofsurgicalsiteinfection AT nurlinamuliani discordancetoashptherapeuticguidelinesincreasestheriskofsurgicalsiteinfection AT kevinkantono discordancetoashptherapeuticguidelinesincreasestheriskofsurgicalsiteinfection AT dianthasoemantri discordancetoashptherapeuticguidelinesincreasestheriskofsurgicalsiteinfection AT retnosariandrajati discordancetoashptherapeuticguidelinesincreasestheriskofsurgicalsiteinfection
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Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection

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