Appropriateness of Surgical Antimicrobial Prophylaxis Practices in Australia

Key Points

Question

What are the current surgical antimicrobial prophylaxis prescribing practices in Australia, and what factors are associated with their appropriateness?

Findings

This quality improvement study of 9351 surgical episodes found high rates of inappropriate procedural and postprocedural antimicrobial use across various hospital, patient, and surgical factors. The most common reason for inappropriate procedural use was incorrect timing, while duration greater than 24 hours was the most common reason for inappropriate postprocedural use.

Meaning

These findings suggest that the identified hospital, patient, and surgical factors should be considered as targets for development of tailored interventions to ensure appropriateness of surgical antimicrobial prophylaxis prescriptions.

Abstract

This quality improvement study uses data from the Australian Surgical National Antimicrobial Prescribing Survey to describe prescribing practices for surgical antimicrobial prophylaxis and assess factors associated with appropriate prescribing.

Abstract

Importance

Surgical antimicrobial prophylaxis (SAP) is a common indication for antibiotic use in hospitals and is associated with high rates of inappropriateness.

Objective

To describe the SAP prescribing practices and assess hospital, surgical, and patient factors associated with appropriate SAP prescribing.

Design, Setting, and Participants

Multicenter, national, quality improvement study with retrospective analysis of data collected from Australian hospitals via Surgical National Antimicrobial Prescribing Survey audits from January 1, 2016, to June 30, 2018. Data were analyzed using multivariable logistic regression. Crude estimates of appropriateness were adjusted for factors included in the model by calculating estimated marginal means and presented as adjusted-appropriateness with 95% confidence intervals.

Main Outcomes and Measures

Adjusted appropriateness and factors associated with inappropriate prescriptions.

Results

A total of 9351 surgical episodes and 15 395 prescriptions (10 740 procedural and 4655 postprocedural) were analyzed. Crude appropriateness of total prescriptions was 48.7% (7492 prescriptions). The adjusted appropriateness of each surgical procedure group was low for procedural SAP, ranging from 33.7% (95% CI, 26.3%-41.2%) for dentoalveolar surgery to 68.9% (95% CI, 63.2%-74.5%) for neurosurgery. The adjusted appropriateness of postprocedural prescriptions was also low, ranging from 21.5% (95% CI, 13.4%-29.7%) for breast surgery to 58.7% (95% CI, 47.9%-69.4%) for ophthalmological procedures. The most common reason for inappropriate procedural SAP was incorrect timing (44.9%), while duration greater than 24 hours was the most common reason for inappropriate postprocedural SAP (54.3%).

Conclusions and Relevance

High rates of inappropriate procedural and postprocedural antimicrobial use were demonstrated across all surgical specialties. Reasons for inappropriateness, such as timing and duration, varied according to the type of SAP and surgical specialty. These findings highlight the need for improvement in SAP prescribing and suggest potential targeted areas for action.