Objectives: The introduction of antimicrobial prophylaxis in surgery was designed and pre-intervention (controls) and post-intervention (cases) evaluations were carried out at a university tertiary hospital.
Patients and method: Prospective recording of information on prophylaxis in all patients undergoing non-emergency abdominal surgery was analysed during a 3-week period before and after implementing an antimicrobial prophylaxis program. Adequacy of prophylaxis was defined as prescription of antibiotics (type, dose and duration of treatment) according to the Guidelines.
Results: In the pre-intervention study: included 36 patients; prophylaxis was inadequate in all patients (long-term in 22 cases; antibiotic class and long-term in 2 cases; antibiotic class, dose and long-term in 12 cases); mean duration of prophylaxis was 6 days (range 1 to 10 days); mean antibiotic cost per patient was 77 euro (range 9 to 412 euro); overall antibiotic cost for the 36 patients was 2770 euro. In the post-intervention study: included 37 patients: prophylaxis was inadequate in 11 patients (long-term in 10 cases; antibiotic class and long-term in 1 case); mean duration of prophylaxis was 2 days (range 1 to 9 days); mean antibiotic cost per patient was 16 euro (range 2 to 78 euro); overall antibiotic cost for the 37 patients was 593 euro. In the pre-intervention period antibiotic cost was 38 times higher than expected. In the post-intervention period it was 1.6 times higher than expected.
Conclusions: The most common reason of prophylaxis inadequacy is prolonged antibiotic treatment. A multidisciplinary intervention that comprises infectious diseases, surgical and pharmacy departments improves prophylaxis prescribing practice and avoids erroneous prescribing of antibiotics with both microbiological and economical cost savings.