Perioperative antibiotic prophylaxisPerioperative antibiotic prophylaxis subprojectsubproject
BARN 4th Workshop, 9-10 October 2013, WarsawBARN 4th Workshop, 9-10 October 2013, Warsaw
Hospital of Lithuanian University of Health Sciences Kauno Klinikos
Institute of Hygiene
dr.G.Gailiene
• AimAim: To evaluate the quality of perioperative antibiotic prophylaxis (the adherence to the local prophylaxis guidelines) in the countries of Baltic Sea region.
• ObjectivesObjectives:– 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;
• 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.
MethodsMethods
PartParticipants of subprojecticipants 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 dataGeneral data Number of beds Hospital of
Lithuanian University of
Health Sciences Kauno Klinikos
(Lithuania)LTLT
Stradins University Hospital
(Latvia)LVLV
Tartu University Hospital
(Estonia) EEEE
West - Tallinn Central
Hospital
(Estonia)EE2EE2
Uppsala University Hospital
(Sweden)SESE
Hospital 1947 822 975 481 1100
ABDOMINAL department
90 75 66 44 -
OBSTETRIC-GYNAECOLOGY
department
60 22 17 55 -
CARDIOSURGERY department
40 46 30 - 25
ResultsResults
AB stewardshipAB stewardship
0 1 2 3 4 5 6
A re meas ures taken to improve c omplianc e?
A re data on c omplianc e fed bac k to the hos pitaladminis tration?
A re data on c omplianc e fed bac k to the s urgic aldepartments ?
A re a s uffic ient number of s urgic al proc eduresinc luded in an audit of P A P ?
Were one or more audits for c omplianc e with the P A Pprotoc ol performed?
Is the hos pital P A P protoc ol regularly updated?
Were the s urgic al proc edures evaluated ac c ording toappropriatenes s of P A P indic ation?
A re patient-s pec ific fac tors taken into c ons iderationwhen updating the P A P -protoc ol?
Is the P A P protoc ol updated + ac c ording to the loc alantimic robial s us c eptibility patterns ?
A B prophylax is guidelines define:
A B prophylax is guidelines s tatus :obligatory
A B prophylax is guidelines s tatus :rec ommendation
Does the A B team have one or more annual plenarymeetings ?
Is there a multidis c iplinary A B -team that c ons is ts ofprofes s ionals from relevant areas ?
Y es
No
•AB doses•AB prescription duration •route of AB administrationalternative AB
SE 2(LV,SE)
3 (LT,EE,EE2)
3(EE,EE2,SE), 2 (LV,LT)
3(EE,EE2,SE)
2 (LV,LT)
3(EE,SE,EE
2) 2(LV,LT) 2(EE,EE2) 3(LV,LT,SE)
3(EE,EE2,SE)
2(LV,LT)
2(EE,EE2);3(LV,LT,SE)
Obstetric – gynaecology Obstetric – gynaecology Types of surgery (N)Types of surgery (N)
Obstetric – gynaecology surgeryObstetric – gynaecology surgeryAB prophylaxis (%)AB prophylaxis (%)
100
0
95.45
0 0 0
98.48
0
55.56
5.56
61.11
05.56
0
22.22
0
18.75
75.068.75
0 0 0 4.35 09.1
40.9
85.71
0 0 0
27.2716.67
0
20
40
60
80
100
120
Patientreceived
AB within 1hr prior toincision
PatientreceivedAB within
15 - 30 minprior toincision
PatientreceivedAB based
on theGuidelines
(first ABdose)
PatientreceivedAB based
on theGuidelines(second AB
dose)
Second ABdose due toprolongedoperation
Second ABdose due toblood loss
(≥1,5 L)
Patientreceived
AB after 24hr
* Patientreceived
AB after 24hr based on
theGuidelines
L T
L V
E E
E E (2)
*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.
AB used for prophylaxis before Obstetric-AB used for prophylaxis before Obstetric- g gynaecology surgery (%)ynaecology surgery (%)
0
10
20
30
40
50
60
70
80
90
100
LT
LV
EE
EE2
CardiosurgeryCardiosurgeryTypes of surgery (N)Types of surgery (N)
CardiosurgeryCardiosurgery
AB prophylaxis (%)AB prophylaxis (%)
* LV - 52.2 % patients received AB more than 1 hr prior to incision
32.0
0.0
24.0
0.0
21.4
78.6
0.0 0.0
64.29
35.71
100.0
28.57 25.0
47.83
0.0
47.83
93.75
0.0
100.0
68.0
100.0 100.0
0
20
40
60
80
100
120
P atientrec eived A Bwithin 1 hr
prior toinc is ion
P atientrec eived A B
within 15 - 30min prior to
inc is ion
P atientrec eived A B
bas ed on theG uidelines
(firs t A B dos e)
P atientrec eived A B
bas ed on theG uidelines
(s ec ond A Bdos e)
P atientrec eived A B
after 24 hr
*P atientrec eived A B
after 24 hrbas ed on the
G uidelines
L T
E E
S E
L V
AB used for prophylaxis before Cardiosurgery (%)AB used for prophylaxis before Cardiosurgery (%)
0102030405060708090
100
LT
LV
EE
SE
Abdominal surgeryAbdominal surgery Types of surgery (N)Types of surgery (N)
Abdominal surgeryAbdominal surgery
AB prophylaxis (%)AB prophylaxis (%) 100.0
0.0
100.0
0.012.90
0.013.04
86.67 82.61
100.0
56.52
0.04.2
41.6
100.0 100.0
0.0 0.012.90
77.4267.74
0.0
81.25
0.00.0
20.0
40.0
60.0
80.0
100.0
120.0
Patie ntre c e ive d A Bw ithin 1 hr
pr ior toinc is ion
Patie ntre c e ive d A B
w ithin 15 -30 m in pr ior
to inc is ion
Patie ntre c e ive d A B
bas e d onthe
Guide line s(firs t A B
dos e )
Patie ntre c e ive d A B
bas e d onthe
Guide line s(s e c ond A B
dos e )
Patie ntre c e ive d A B
afte r 24 hr
*Patie ntre c e ive d A B
afte r 24 hrbas e d on
theGuide line s
L T
E E
E E (2)
L V
*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.
0
10
20
30
40
50
60
70
80
90
LTLVEEEE2
AB used for prophylaxis before Abdominal surgery (%)AB used for prophylaxis before Abdominal surgery (%)
AB appointment before surgery (%)AB appointment before surgery (%)
Surgery LTLT LVLV EEEE EE2EE2 SESE
Obstetric-gynaecology
Anesthesiologist+Surgeon – 100%
Surgeon – 100%
AnesthesioloAnesthesiologist– 100% gist– 100%
Surgeon – 100%
-
Cardiosurgery Anesthesiologist - 96%
Surgeon – 4 %
Anesthesiologist–
100%
AnesthesioloAnesthesiologist– 100% gist– 100%
- Anesthesiologist – 100%
Abdominal Anesthesiologist+Surgeon – 100%
Anesthesiologist+Surg
eon – 100%
AnesthesioloAnesthesiologist– 100% gist– 100%
Anesthesiologist– 84.6%
Surgeon – 15.4%
-
ResumeResume::• 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.
RecommendationsRecommendations
• 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 attentionThank you for attention
