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Adherence to guidelines for antibiotic prophylaxis in surgery patients in German hospitals: a multicentre evaluation involving pharmacy interns

  • Clinical and Epidemiological Study
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Abstract

Background and aim

Surgical site infections (SSIs) are associated with a high morbidity, mortality and healthcare costs. The prevention of SSIs is based on a combination of preoperative preparation, surgical techniques, perioperative antibiotic prophylaxis (PAP) and postoperative wound care. Despite an abundance of evidence demonstrating the effectiveness of antimicrobials to prevent SSIs, the use of antimicrobial prophylaxis in this clinical setting is associated with inappropriate timing and selection and excessive duration of administration. To date, pharmacy interns (PIs) have not been involved in this process. The aim of this study was to evaluate feasibility of involving PIs in monitoring adherence to the guidelines for antibiotic prophylaxis in surgery patients.

Methods

The study was conducted in seven hospitals in Germany within the framework of the project “Pharmacy interns on the ward” (P-STAT2). Twenty-seven PIs participated, either from either May to October 2008 or from November 2008 to April 2009. Each patient admitted to the participating wards was consecutively monitored. PIs documented the antibiotic prophylaxis and checked the adherence with the hospital ward’s PAP guidelines taking both the choice of antibiotic drug and the duration of PAP into account. The costs of antibiotics, personnel and material were calculated in cases of non-adherence with guidelines.

Results

This is the first time that PIs were involved in monitoring antibiotic prophylaxis guidelines. A total of 6,167 patients were enrolled (mean age 58.3 ± 19.6 years; 47.1% male); of these, 5,064 patients underwent surgery and were ultimately available for evaluation. Guidelines for antibiotic prophylaxis were followed in 70.7% of the cases.

Conclusions

The study revealed that many patients do not receive the appropriate antibiotic prophylaxis despite the fact that guidelines are in place. Based on these results, we conclude that PIs may play an important role in antibiotic prophylaxis management.

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Abbreviations

IV:

Intravenous

n/a:

Not available

PAP:

Perioperative antibiotic prophylaxis

PI:

Pharmacy intern

SSI:

Surgical site infection(s)

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Acknowledgments

We thank all participating pharmacies: Dom-Apotheke, Essen; Asklepios Kliniken Hamburg GmbH; Waisenhaus-Apotheke, Halle; Universitätsklinikum Heidelberg; Klinikum Fulda gAG; Klinikum rechts der Isar der TU München; and Dr.-Horst-Schmidt-Kliniken GmbH, Wiesbaden (Germany) and all pharmacy interns for their valuable contributions. We thank Christiane Sauerwein (ZAPP, ABDA, Berlin) for generating the database and her contribution in the analysis process and Susanne vom Scheidt (ZAPP, ABDA, Berlin) for her support in running the study. The main sponsor of this study was the Federal Union of German Associations of Pharmacists (ABDA), Berlin, Germany; the co-sponsor was Dr. August und Dr. Anni Lesmüller-Foundation, Munich, Germany.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Medicine, Centre for Drug Information and Pharmacy Practice (ZAPP), Federal Union of German Associations of Pharmacists (ABDA), Jaegerstraße 49-50, 10117, Berlin, Germany

    C. Hohmann, C. Eickhoff & M. Schulz

  2. Department of Pharmacy, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany

    C. Hohmann & R. Radziwill

  3. Department of Pharmacology and Clinical Pharmacy, Philipps-University, Marburg, Germany

    R. Radziwill

  4. Department of Pharmacology, Goethe-University Frankfurt, Frankfurt, Germany

    M. Schulz

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  1. C. Hohmann
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  2. C. Eickhoff
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  3. R. Radziwill
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  4. M. Schulz
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Corresponding author

Correspondence to C. Hohmann.

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Hohmann, C., Eickhoff, C., Radziwill, R. et al. Adherence to guidelines for antibiotic prophylaxis in surgery patients in German hospitals: a multicentre evaluation involving pharmacy interns. Infection 40, 131–137 (2012). https://doi.org/10.1007/s15010-011-0204-7

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  • DOI: https://doi.org/10.1007/s15010-011-0204-7

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