Antibiotic Prophylaxis in Acute Surgical Procedures – The Current Praxis in Czech Republic

Česká verzia

Authors: O. Ryska; Z. Šerclová; E. Konečná; J. Fulík; T. Kneifl; P. Dytrych ; J. Marx; F. Antoš
Authors place of work: Chirurgická klinika, Fakultní nemocnice Na Bulovce, Praha
Published in the journal: Rozhl. Chir., 2011, roč. 90, č. 7, s. 402-407.
Category: Monothematic special - Original

Summary

Introduction:
Surgical site infections (SSI) are currently one of the most frequent postoperative complications. Emergent surgery is generally subject to a higher risk of SSI. Antibiotic prophylaxis is one of many measures that should be taken to prevent postoperative infection. However, due to possible adverse effects it must be applied only in indicated cases. Many guidelines have been published abroad, but still missing in Czech Republic. Standard use of prophylaxis can be currently followed due to compliance with SCIP (Surgical Care Improvement Project) measurements and reflects the quality of surgical care.

Objectives:
The aim of our study was to evaluate the current clinical praxis of prophylactic antibiotic administration in Czech Republic in emergent surgery for diagnosis: acute appendicitis, small bowel obstruction and perforated gastroduodenal ulcer and evaluate the SCIP criteria adherence.

Method:
The survey was sent to 149 surgical departments. The questionnaire included 7 questions and feedback was considered to be anonymous. The compliance with 3 main SCIP measurements (INF-1, INF-2, INF-3) was evaluated by the patients with acute appendicitis as a indication for emergent surgery.

Results:
Overall, 85 (57%) completed questionnaires were received back. According to a survey results, antibiotic prophylaxis is always administered in 15% of patients operated for acute appendicitis, 27% operated for small bowel obstruction and 47% of patients with gastroduodenal perforation. No prophylaxis is given in 11 (13%) hospitals for either of the mentioned diagnoses. Antibiotics are mostly (46 %) administered at induction of general anesthesia and extended to 24 hours. The SCIP measurements adherence was as follows: INF-1 – 4.7%; INF-2 – 86 %; INF-3 – 81 % of evaluated departments. All of 3 (all-or-none) criteria were fulfilled only at 3 (3.5%) surgical departments.

Conclusion:
The clinical praxis of antibiotic prophylaxis in urgent surgical procedures in Czech Republic is highly variable and mostly ignores the current international guidelines (SCIP). There is a need of local specific guideline concerning antibiotic prophylaxis guaranteed by scientific company.

Key words:
antibiotic prophylaxis – surgical site infection – emergent surgery

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