Allison Muller1, Joel Leroy2, Thierry Hénon3, Isabelle Patry4, Emmanuel Samain5, Catherine Chirouze2, Xavier Bertrand6. 1. UMR 6249 chrono-environnement, service d'hygiène hospitalière, centre hospitalier régional universitaire, 3, boulevard Fleming, 25000 Besançon, France. Electronic address: a3muller@chu-besancon.fr. 2. UMR 6249 chrono-environnement, service des maladies infectieuses, centre hospitalier régional universitaire, 3, boulevard Fleming, 25000 Besançon, France. 3. Pharmacie centrale, centre hospitalier régional universitaire, 3, boulevard Fleming, 25000 Besançon, France. 4. Service de bactériologie, centre hospitalier régional universitaire, 3, boulevard Fleming, 25000 Besançon, France. 5. Pôle d'anesthésie-réanimation chirurgicale, centre hospitalier régional universitaire, 3, boulevard Fleming, 25000 Besançon, France. 6. UMR 6249 chrono-environnement, service d'hygiène hospitalière, centre hospitalier régional universitaire, 3, boulevard Fleming, 25000 Besançon, France.
Abstract
OBJECTIVE: To assess surgical antibiotic prophylaxis (SAP) practices in a university hospital in order to identify risk factors associated with non-compliance. STUDY DESIGN: Retrospective monocentric study conducted over a 4-month period. PATIENTS AND METHODS: Data were collected from the software used in the operating theatre. Practice non-compliance was evaluated in comparison with the 2010 version of the French national recommendations. We only took in account the interventions identified as priority surveillance interventions according to the surgical site infections national surveillance. The risk factors associated with SAP non-compliance were identified with a multivariate statistical analysis. RESULTS: We evaluated 1312 SAPs. Among the 1298 indicated SAPs, 44.4% were not compliant. The most frequent inappropriate criterion was the timing of injection (34.8% non-compliance), which was, in the majority of cases, too close to the time of incision. Other inappropriate criteria were identified: antibiotic choice for patients allergic to β-lactams (inappropriate among 45% of allergic patients), and antibiotic dosing for obese patients (96% of non-compliance). Obesity (OR=84.32), allergy to β-lactams (OR=17.11) and certain types of surgery (digestive, OR=4.56; gynaecological and obstetrical, OR=7.10; urological, OR=3.95) were independently associated with the non-compliance of SAP practices. CONCLUSION: Improvement measures that target the timing of injection, obese or allergic patients are necessary.
OBJECTIVE: To assess surgical antibiotic prophylaxis (SAP) practices in a university hospital in order to identify risk factors associated with non-compliance. STUDY DESIGN: Retrospective monocentric study conducted over a 4-month period. PATIENTS AND METHODS: Data were collected from the software used in the operating theatre. Practice non-compliance was evaluated in comparison with the 2010 version of the French national recommendations. We only took in account the interventions identified as priority surveillance interventions according to the surgical site infections national surveillance. The risk factors associated with SAP non-compliance were identified with a multivariate statistical analysis. RESULTS: We evaluated 1312 SAPs. Among the 1298 indicated SAPs, 44.4% were not compliant. The most frequent inappropriate criterion was the timing of injection (34.8% non-compliance), which was, in the majority of cases, too close to the time of incision. Other inappropriate criteria were identified: antibiotic choice for patientsallergic to β-lactams (inappropriate among 45% of allergicpatients), and antibiotic dosing for obesepatients (96% of non-compliance). Obesity (OR=84.32), allergy to β-lactams (OR=17.11) and certain types of surgery (digestive, OR=4.56; gynaecological and obstetrical, OR=7.10; urological, OR=3.95) were independently associated with the non-compliance of SAP practices. CONCLUSION: Improvement measures that target the timing of injection, obese or allergicpatients are necessary.