#34 Evaluation of surgical antibiotic prophylaxis at tertiary level pediatric hospital in Mexico City
Authors: de Costta Michuy María los Ángeles 
Published: June 2022

Background

There is certainty that surgical antibiotic prophylaxis is useful in the prevention of surgical site infection. However, it should be chosen with a spectrum aimed at microorganisms that, due to the type of surgery, could cause an infection and reduce events should be prescribed at correct doses and with the minimum duration. Surgical services are in constant change, it seems that the demands on the personal physician to be in the surgery room and to attend to those worrisome needs of the patient make the responsibility for making decisions about antibiotics uncoordinated. For this reason, the prescription of antimicrobials can be perceived as a secondary task and one that is even delegated to young surgical members. The objective of this study was to describe the most frequent errors in surgical prophylaxis prescription.

Method

This is an analytic transverse study in a six-month period (November 2020-March2021), that includes antibiotic prescriptions on surgical departments (orthopedics, general surgery, urology, plastic surgery, neurosurgery, oncologic surgery, otorhinolaryngology). For variable analysis, a Chi-square test, odds ratio and etiological fraction among exposed will be performed.

Results

423 antibiotic prescriptions were analyzed, 210 achieved inclusion criteria and 190 were indicated as surgical antibiotic prophylaxis, 118 of these have at least one error in prescription. The odds ratio for prescription errors and the indication of antibiotics as prophylaxis (Pearson chi square test 16.442 p 0.00) were 9.29 (CI 95% 2.63-32.8), etiological fraction among exposed were 89.23%. Table 1 shows surgical antibiotic prescriptions for services in descending order, although the patients were from surgery services, the prescriptions were not always made form the same service (for example anesthesiology) and the number error prescriptions to show which areas should be trained in prescribing antibiotics. The most frequent errors in the initial prescription of antibiotics that were documented corresponded to not indicating the time of administration of the antibiotic in the case of surgical prophylaxis and dosage. After applying the “Time out” strategy, the most documented error was the prolongation of antibiotic prophylaxis. The most frequently prescribed pharmacological group of antibiotics corresponded to cephalosporins.

Conclusion

Antimicrobial education or restriction strategies are required to correct the high percentage of errors observed in antibiotic prescriptions. Knowing this baseline state is the initial step for the formulation of antimicrobial use optimization programs that reduce adverse events, costs, and local antimicrobial resistance rates. Despite having statistically significant data between prescription errors and the indication of antibiotics as prophylaxis, the heterogeneity of the services prescribed does not make a conclusion of the probability of occurrence of the event possible, however it shows the services that need more training in the prescription of antibiotics.