Transcript Slide 1

Perioperative antibiotic prophylaxis
subproject
BARN 4th Workshop, 9-10 October 2013, Warsaw
Hospital of Lithuanian University of Health
Sciences Kauno Klinikos
Institute of Hygiene
dr.G.Gailiene
• Aim: To evaluate the quality of perioperative antibiotic prophylaxis
(the adherence to the local prophylaxis guidelines) in the countries of
Baltic Sea region.
• Objectives:
– Evaluation of existing local AB stewardship;
– Estimation of patients, who received AB within 1 hr – 15 min
prior to incision;
– Estimation of patients, who received AB based on the local
guidelines;
– Estimation of patients, who received AB after 24 hr;
– Antibiotics used for prophylaxis;
Methods
• Multicenter prospective observational study;
• Duration 2 weeks (10 working days);
• Pilot study was performed in November-December 2012 in General
Surgery Department and Orthopedic Department of Hospital of
Lithuanian University of Health Sciences Kauno Klinikos.
• Main study – March - June 2013 – in departments of:
– Obstetric - Gynaecology,
– Cardiosurgery;
– General Surgery.
Participants of subproject:
• Greta Gailiene, Zilvinas Dambrauskas, Hospital of Lithuanian
University of Health Sciences Kauno Klinikos, Lithuania;
• Uga Dumpis, Aija Vilde, Pauls Stradini University Hospital, Latvia;
• Piret Mitt, Tartu University Hospital, Estonia;
• Pille Martin, West - Tallinn Central Hospital, Estonia;
• Birgitta Lytsy, Uppsala University Hospital, Sweden.
General data
Number of beds
Hospital of
Lithuanian
University of
Health Sciences
Kauno Klinikos
Stradins
University
Hospital
Tartu
University
Hospital
West - Tallinn
Central
Hospital
Uppsala
University
Hospital
(Lithuania)
LT
(Latvia)
LV
(Estonia)
EE
(Estonia)
EE2
(Sweden)
SE
Hospital
1947
822
975
481
1100
ABDOMINAL
department
90
75
66
44
-
OBSTETRICGYNAECOLOGY
department
60
22
17
55
-
CARDIOSURGERY
department
40
46
30
-
25
Results
AB stewardship
SE
2(LV,SE)
Is there a multidis c iplinary A B -team that c ons is ts of
profes s ionals from relevant areas ?
Does the A B team have one or more annual plenary
meetings ?
3 (LT,EE,EE2)
A B prophylax is guidelines s tatus :rec ommendation
•AB doses
•AB prescription duration
•route of AB administration
alternative AB
A B prophylax is guidelines s tatus :obligatory
A B prophylax is guidelines define:
3(EE,EE2,SE),
2 (LV,LT)
Is the P A P protoc ol updated + ac c ording to the loc al
antimic robial s us c eptibility patterns ?
A re patient-s pec ific fac tors taken into c ons ideration
when updating the P A P -protoc ol?
W ere the s urgic al proc edures evaluated ac c ording to
appropriatenes s of P A P indic ation?
3(EE,EE2,SE)
2 (LV,LT)
Y es
No
Is the hos pital P A P protoc ol regularly updated?
3(EE,SE,EE
2) 2(LV,LT)
W ere one or more audits for c omplianc e with the P A P
protoc ol performed?
A re a s uffic ient number of s urgic al proc edures
inc luded in an audit of P A P ?
A re data on c omplianc e fed bac k to the s urgic al
departments ?
A re data on c omplianc e fed bac k to the hos pital
adminis tration?
2(EE,EE2)
3(LV,LT,SE)
3(EE,EE2,SE)
2(LV,LT)
2(EE,EE2);
3(LV,LT,SE)
A re meas ures taken to improve c omplianc e?
0
1
2
3
4
5
6
Obstetric – gynaecology
Types of surgery (N)
Obstetric – gynaecology surgery
AB prophylaxis (%)
120
100
85.71
75.0
80
60
98.48
95.45
100
55.56
68.75
61.11
LT
40.9
LV
40
20
18.75
9.1
27.27
22.22
5.56
0
0 0 00
5.56
0 0
0
0 00 0
4.35
16.67
0 00
0
Patient
Patient
Patient
Patient
received
received
received
received
AB within 1 AB within AB based AB based
hr prior to 15 - 30 min
on the
on the
incision
prior to Guidelines Guidelines
incision
(first AB (second AB
dose)
dose)
Second AB Second AB Patient
* Patient
dose due to dose due to received
received
prolonged blood loss AB after 24 AB after 24
operation
(≥1,5 L)
hr
hr based on
the
Guidelines
*LV - 38.9 % patients received AB more than 1 hr prior to incision;
** EE - 1 (4.3%) patient received AB 8 min after incision; 30.4% patients
did not received AB before operations
(PAP is indicated only for hysterectomy, but 4 (out of 10) patients with ovarian surgery received PAP);
*** EE (2) 45.4 % patients received AB more than 1 hr prior to incision, 4.5% patients did not received AB.
EE
E E (2)
AB used for prophylaxis before Obstetric- gynaecology surgery (%)
100
90
80
LT
LV
EE
EE2
70
60
50
40
30
20
10
0
a
nd
cli
c in
my
n
im
ox
r
fu
ce
i
xit
fo
ce
ro
et
+m
im
ox
r
fu
ce
n
oli
faz
ce
Cardiosurgery
Types of surgery (N)
Cardiosurgery
AB prophylaxis (%)
120
100.0
100.0
100.0
100.0
100
80
93.75
78.6
68.0
64.29
60
47.83
40
47.83
32.0
LT
35.71
24.0
21.4
28.57
EE
25.0
20
SE
LV
0.0
0.0
0.0
0.00.0
0.0
0
P atient
rec eived A B
within 1 hr
prior to
inc is ion
P atient
P atient
rec eived A B
rec eived A B
within 15 - 30 bas ed on the
min prior to
G uidelines
inc is ion
(firs t A B dos e)
P atient
rec eived A B
bas ed on the
G uidelines
(s ec ond A B
dos e)
P atient
rec eived A B
after 24 hr
*P atient
rec eived A B
after 24 hr
bas ed on the
G uidelines
* LV - 52.2 % patients received AB more than 1 hr prior to incision
AB used for prophylaxis before Cardiosurgery (%)
100
90
80
70
60
50
40
30
20
10
0
LT
LV
EE
SE
xc
im
en
+g
im
n
n
illi
x
ro
fu
x
ro
fu
oli
faz
klo
ce
ce
ce
ta
Abdominal surgery
Types of surgery (N)
Abdominal surgery
AB prophylaxis (%)
120.0
100.0
100.0
100.0100.0
86.67
77.42
80.0
100.0
100.0
82.61
67.74
81.25
56.52
60.0
41.6
40.0
20.0
13.0412.90
4.2
LT
12.90
0.0
0.0
0.0
0.0
0.00.00.00.0
0.0
Patie nt
Patie nt
Patie nt
Patie nt
Patie nt
*Patie nt
re c e ive d A B re c e ive d A B re c e ive d A B re c e ive d A B re c e ive d A B re c e ive d A B
w ithin 1 hr
w ithin 15 bas e d on
bas e d on
afte r 24 hr afte r 24 hr
prior to
30 m in prior
the
the
bas e d on
inc is ion
to inc is ion Guide line s
Guide line s
the
(firs t A B
(s e c ond A B
Guide line s
dos e )
dos e )
*EE - 1 (2.2%) patient received AB after incision;
** EE (2) - 12.5% patients received first dose of AB on time of incision or after incision;
41.6 % patients did not received AB before operations;
*** LV - 9.7 % patients received AB after incision.
EE
E E (2)
LV
AB used for prophylaxis before Abdominal surgery (%)
90
LT
LV
EE
EE2
80
70
60
50
40
30
20
10
0
n
n
e
i
xit
efo
+c
lin
o
faz
ce
i
xit
fo
ce
li
cil
on
iax
ftr
ce
ni
pe
n
o
etr
o
etr
m
a+
nt
ge
im
ox
pi+
r
fu
ce
am
+m
lin
o
faz
ce
lin
o
faz
ce
AB appointment before surgery (%)
Surgery
LT
LV
EE
EE2
SE
Obstetricgynaecology
Anesthesiologist
+Surgeon –
100%
Surgeon –
100%
Anesthesiologist
– 100%
Surgeon –
100%
-
Cardiosurgery
Anesthesiologist
- 96%
Surgeon – 4 %
Anesthesiologi
st– 100%
Anesthesiologist
– 100%
-
Anesthesio
logist –
100%
Abdominal
Anesthesiologist
+Surgeon –
100%
Anesthesiologi
st+Surgeon –
100%
Anesthesiologist
– 100%
Anesthesiolo
gist– 84.6%
Surgeon –
15.4%
-
Resume:
•
Multidisciplinary AB-team has only one hospital (20.0%).
•
PAP protocol updated according to the local antimicrobial susceptibility patterns in 3
hospitals (60.0%).
•
One or more audits for compliance with the PAP protocol are performed in 2 hospitals
(40.0%).
•
Antibiotic timing (1 h or 15 - 30min.) and appointment (surgeon or anesthesiologist, or
both) before operation depends on the type of surgery, i.e. depends on ward, but not
on hospital (except Tartu university hospital).
•
Patients received AB more than 1 hr prior incision in 2 hospitals, in 3 hospitals - AB
after incision.
•
4.35 – 98.5 % of patient received AB after 24 hr in all (5) hospitals, based on the
Guidelines – in 2 hospitals.
•
1st and 2nd gen cephalosporins or combinations with other antibiotics were used
most common for prophylaxis.
Recommendations
• Repeat study;
• Expand:
– number of participating:
• persons
• departments
• countries
– duration of study
– protocol (AB name, dose, precise injection or
oral administration time)
Thank you for attention