Adherence to guidelines for antibiotic prophylaxis in general surgery: a critical appraisal

Received 24 April 2007; returned 2 July 2007; revised 11 September 2007; accepted 2 October 2007Objectives: To evaluate the adherence of general surgeons to guidelines for antimicrobial prophylaxis.This study was held from January 2000 until October 2000 in a General Surgery Clinic in a hospital inAthens, Greece.Methods: Eight hundred and ninety-eight patients were enrolled and operated on electively.Questionnaires concerning demographic data, health status, type of surgery (clean and clean-contaminated) and parameters of antibiotic prophylaxis (antibiotic choice, route, dose, timing of firstdose, timing of operative redosing and duration of prophylaxis) were completed.Results: Of the patients, 44.8% underwent a clean surgical operation and 55.2% underwent a clean-contaminated surgical operation. Inguinal hernia repair and laparoscopic cholecystectomy were thecommonest operations in each category. Second-generation cephalosporins were the most frequentlyprescribed antibiotics, in 67%. Although, only 78.5% of procedures required prophylaxis, it was admi-nistered in 97.5%, so it was not justified and inappropriately administered in 19%. It was revealed that100% of patients received antibiotic prophylaxis on time. The choice of antimicrobial agent wasappropriate in 70% and the duration of prophylaxis was optimal in 36.3%. The overall compliance rateof surgeons with guidelines for antibiotic prophylaxis was 36.3%.Conclusions: Adherence to separate aspects of guidelines for surgical prophylaxis has to be improved.The duration of antibiotic prophylaxis was the main parameter of interest. Interventions have to bemade about the development, distribution and adoption of adequate guidelines in collaboration withsurgeons.Keywords: compliance, antimicrobial prophylaxis, surgical operations