Perioperatif Antimikrobiyal Profilaksi Uygulamalarında Rehberlere Uyum: Çok Merkezli Bir Çalışma

Year 2017, , 8 - 15, 30.12.2016

Funda Koçak İlker İnanç Balkan , Aygül Doğan Çelik Bülent Durdu Aslıhan Demirel , Serap Gençer , Hava Yılmaz Fatma Ekşi Polat Bahri Teker Aziz Öğütlü Aynur Engin , Alper Şener Mesut Yılmaz Serpil Öztürk Özkan İlknur Esen Yıldız Derya Öztürk Engin Muhammed Emin Doğan Oğuz Karabay

https://doi.org/10.21673/anadoluklin.268873

Cited By: 1

Abstract

Amaç:
Perioperatif Antimikrobiyal Profilaksi (PAP) uygulamalarında güncel rehberlere
uyum oranlarını ve bu oranı etkileyen faktörleri belirlemek.

Gereç
ve Yöntemler: Çoktan
seçmeli ve açık uçlu 40 soruluk anket hazırlanarak farklı branşlardan
cerrahlara bire-bir görüşme yöntemiyle uygulandı. Anket çıktıları uygun
istatistiksel yöntemlerle analiz edildi.

Bulgular: 30
Mayıs - 30 Haziran 2013 tarihleri arasında 15 farklı merkezde uygulanan ankete yedi
farklı branştan 410 cerrah katıldı. Ortalama yaş 38,01±9.1, %83.4’ü erkek idi. Ankete
katılan cerrahların %46.2’si "kurumlarında cerrahi profilaksi rehberi
varlığı hakkında bilgisi olmadığını", %34’ü ise "rehberin bulunduğunu
ve profilaksi uygulamalarının rehbere uygun olduğunu" belirtti. Ankete
katılan cerrahların %56.1’inin kurum içinde cerrahi profilaksi konusunda herhangi
bir eğitim toplantısına katılmadığı, son üç yıl içinde cerrahi profilaksi
eğitimi alanlarda rehbere uyumun istatistiksel olarak daha yüksek olduğu
belirlendi (p <0.001). Kardiyovasküler cerrahlarda uyum diğer cerrahi
branşlara göre anlamlı olarak daha yüksek saptandı (p=0.012). Profilaksi süresi
katılımcıların % 56’sında 24 saatten uzun idi. Dren kullanılan girişimlerde
cerrahların %63.7’sinin cerrahi profilaksiyi dren çekildikten sonra
sonlandırdığı belirlendi. Ürologların 2. kuşak ve 3. kuşak sefalosporinleri
anlamlı olarak (p<0.001, p=0.002) daha sık kullandığı belirlendi.
Cerrahların %87,6’sı cerrahi profilakside kullanılan antibiyotikte rotasyonel
değişiklik yapmadığını ifade etti. Merkezlerin %33’ünde 24 saat enfeksiyon
konsültasyonu ve mikrobiyoloji laboratuvarı olanağı bulunmadığı belirtildi. “Cerrahi
profilaksi rehberlerine uyumu engelleyen en önemli nedenler nelerdir?” sorusu
%50 oranında yanıtsız bırakıldı. En önemli nedenler; “çalışılan kurumdaki
hastane enfeksiyonları ve etken mikroorganizmalar hakkında düzenli bilgi
verilmemesi” (%30), "profilaktik ilacın sağlık personeli tarafından
planlanan zaman ve dozda uygulanmaması" (%27) ve "kurum içi PAP
rehberinin hekim tarafından yetersiz bulunması" (%17) şeklinde belirlendi. 

Tartışma ve Sonuç: Kanıta dayalı
PAP uygulamalarının yerleşebilmesi için bilimsel rehberler ve kurum içi
kılavuzların varlığı kadar bu kılavuzların hazırlık aşamasında cerrahi
birimlerin etkin katılımı, düzenli eğitim ve geri bildirim toplantıları ile
branşlar arası aktif iletişimin mutlaka sürdürülmesi de son derece önemlidir.

Keywords

Perioperatif, antimikrobiyal, profilaksi

Compliance with Guidelines for Practices of Perioperative Antimicrobial Prophylaxis: A Multicenter Survey

Abstract

Aim: We aimed to determine the rates of compliance with current guidelines for practices of
perioperative antimicrobial prophylaxis (PAP) and the factors affecting these rates.

Materials and Methods: Four hundred and ten surgeons from seven different branches attended
the survey conducted between May 30 and June 30, 2013, in fifteen different centers. A 40-question questionnaire consisting of multiple choice and open-ended questions was prepared and applied by interviewing
the surgeons.

Results: The mean age was 38.01 ± 9.1 years; and 83.4% of the participants were male. Of the surveyed surgeons 46.2%
stated that they had no information about the existence of any guidelines for surgical prophylaxis in their institutions and 34%
stated that institutional guidelines were available and their prophylaxis practices were in accordance with them. Surgeons
who were trained on surgical prophylaxis within the last three years were found to have a statistically higher (p<0.001) rate
of compliance with the guidelines. Compared to surgeons from other branches, compliance rates in cardiovascular surgeons
were statistically significantly higher (p=0.012). The duration of prophylaxis applied was longer than 24 hours in 56% of the
participants. In procedures involving drains, 63.7% of the surgeons stated that they preferred to terminate surgical prophylaxis
after removing the drainage tube. It was found that urologists used second and third generation cephalosporins statistically
significantly more frequently (p<0.001; p=0.002). Of the surgeons 87.6% stated that they did not rotationally change the
antibiotics they used for surgical prophylaxis. It was found that 33% of the centers did not have 24-hour infection consultation
and microbiology laboratory facilities. The question “What are the most important reasons for failure in compliance with
surgical prophylaxis guidelines?” was left unanswered by 50% of the participants. The most important reasons of incompliance
were found to be “lack of regular feedback about hospital infections and the pathogenic microorganisms” (30%), “failure
in application of the prophylactic agent in accordance with the timing and dosing determined by the healthcare personnel”
(27%), and physicians’ view that institutional PAP guidelines were insufficient (17%).

Discussion and Conclusion: Besides the existence of institutional guidelines for the establishment of evidence-based PAP
practices, it is also crucial to provide active participation of surgical healthcare units in the preparation of these guidelines
and to maintain regular training and feedback meetings and active communication between medical branches.

Keywords

perioperative, antimicrobia, prophylaxis

References

• 1. Hoşoglu S, Aslan S, Akalın S, Boşnak V. Audit of quality of perioperative antimicrobial prophylaxis. Pharm World Sci. 2009; 31: 14–7.
• 2. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm. 2013; 70:195-283.
• 3. Tourmousoglou CE, Yiannakopoulou E,Kalapothaki V, Bramis J, St Papadopoulos J. Adherence to guidelines for antibiotic prophylaxis in general surgery: a critical appraisal. J Antimicrob Chemother. 2008; 61: 214-218.
• 4. Al-Momany NH, Al-Bakri AG , Makahleh ZM, Wazaify MM. Adherence to international antimicrobial prophylaxis guidelines in cardiac surgery: a Jordanian study demonstrates need for quality improvement. J Manag Care Pharm. 2009; 15:262-271.
• 5. Ozgün H, Ertugrul BM, Soyder A, Ozturk B, Aydemir M. Peri-operative antibiotic prophylaxis: adherence to guidelines and effects of educational intervention. Int J Surg. 2010; 8: 159-163.
• 6. Classen DC., Evans RS., Pestotnik SL., Horn SD., Menlove RL., J.P. Burke. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med. 1992; 326: 281–286.
• 7. Harbarth S, Samore MH, Lichtenberg D., Carmeli Y. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance Circulation. 2000; 101: 2916–2921.
• 8. Özkurt Z, Kadanalı A, Ertek M, Erol S, Parlak M. Antibiotic use in surgical prophylaxis. J Ankem 2005; 19: 111–4.
• 9. Özgün H, Ertugrul BM, Soyder A, Öztürk B, Aydemir M. Peri-operative antibiotic prophylaxis: Adherence to guidelines and effects of educational intervention. Intern J Surg. 2010; 8: 159–163.
• 10. Lallemand S, Thouverez M, Bailly P, Bertrand X, Talon D. Non-observance of guidelines for surgical antimicrobial prophylaxis and surgical-site infections. Pharm World Sci. 2002; 24: 95–9.
• 11. Mannien J, van Kasteren ME, Nagelkerke NJ, Gyssens IC, Kullberg BJ, Wille JC, et al. Effect of optimized antibiotic prophylaxis on the incidence of surgical site infection. Infect Control Hosp Epidemiol. 2006; 27: 1340–6.
• 12. Yalcin AN, Erbay RH, Serin S, Atalay H, O ner O, Yalcin AD. Perioperative antibiotic prophylaxis and cost in a Turkish University Hospital. Infez Med 2007;15:99-104.
• 13. Kaya S, Aktaş S, Şenbayrak S, Tekin R, Öztoprak N, Aksoy F ve ark. An Evaluation of Surgical Prophylaxis Procedures in Turkey:A Multi Center Point Prevalence Study. Eurasian J Med. 2016 Feb;48(1):24-8.
• 14. Hoşoğlu S, Sünbül M, Erol S, Altındiş M, Çaylan R, Demirdağ K, ve ark. A national survey of surgical antibiotic prophylaxis in Turkey. Infect Control Hosp Epidemiol. 2003; 24: 758-761.
• 15. Kulkarni R, Kochhar P, Dargude V, Rajadhyakshya S, Thatte U. Patterns of antimicrobial use by surgeons in India. Indian J Surg. 2005; 67: 308-315.
• 16. Gyssens IC, Geerligs IE, Dony JM, van der Vliet JA, van Kampen A, van den Broek PJ, et al. Optimising antimicrobial drug use in surgery: an intervention study in a Dutch university hospital. J Antimicrob Chemother 1996; 38: 1001–12.
• 17. Martone WJ, Nichols RL. Recognition, prevention, surveillance, and management of surgical site infections: introduction to the problem and symposium overview. Clin Infect Dis. 2001; 33(S2): 67–68
• 18. Versporten A, Bolokhovets G, Ghazaryan L, Abilova V, Pyshnik G, Spasojevic T et al.
• Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe. Lancet Infect Dis. 2014; 14(5): 381–387.
• 19. Al-Azzam SI, Alzoubi KH, Mhaidat NM , Haddadin RD, Masadeh NM, Tumah HN et al. Preoperative antibiotic prophylaxis practice and guideline adherence in Jordan: a multi-centre study in Jordanian hospitals. J Infect Dev Ctries. 2012; 6(10): 715-20.
• 20. Sekimoto M, Imanaka Y, Evans E, Ishizaki T, Hirose M, Hayashida K, et al. Practice variation in perioperative antibiotic use in Japan. Int J Qual Health Care. 2004; 16: 367-373.
• 21. Gould IM. Introduction: Antibioticprophylaxis in clean surgery. J Chemother 2001; 13: 80-83.
• 22. Sanabria A, Dominguez LC, Valdivieso E, Gomez G. Prophylactic antibiotic for mesh inguinal hernioplasty: a metaanalysis. Ann Surg. 2007; 245: 392–6.
• 23. Martin C. Antimicrobial prophylaxis in surgery: general concepts and clinical guidelines. French Study Group on Antimicrobial Prophylaxis in Surgery, French Society of Anesthesia and Intensive Care. Infect Control Hosp Epidemiol. 1994; 15: 463–71.
• 24. Kaiser AB. Antimicrobial prophylaxis in surgery. N Engl J Med. 1986; 315: 1129–38.
• 25. Colizza S, Rossi S, Daffina A. Questionnaire survey of perioperative antibiotic prophylaxis in Italian surgical departments. J Chemother. 2002; 14(1): 59-64.
• 26. Bull AL, Russo PL, Friedman ND, Bennett NJ, Boardman CJ, Richards MJ. Compliance with surgical antibiotic prophylaxis-reporting from a statewide surveillance programme in Victoria, Australia. J Hosp Infect. 2006; 63: 140-147.
• 27. Zelenitsky SA, Ariano RE, Harding GK, Silverman RE. Antibiotic pharmacodynamics in surgical prophylaxis: an association between intraoperative antibiotic concentrations and efficacy. Antimicrob Agents Chemother. 2002; 46: 3026-3030.
• 26. Burke JP. Infection control - a problem for patient safety. N Engl J Med 2003; 348:651- 656.
• 29. van Kasteren ME, Mannien J, Kullberg BJ, de Boer AS, Nagelkerke NJ, Ridderhof M, et al. Quality improvement of surgical prophylaxis in Dutch hospitals: evaluation of a multi-site intervention by time series analysis. J Antimicrob Chemother. 2005; 56: 1094–102.
• 30. D. Pittet, G. Ducel. Infectious risk factors related to operating rooms. Infect Control Hosp Epidemiol. 1994; 15: 456–462.