Evaluation of the appropriateness of prophylactic antimicrobial use in general surgery patients

Surgical site infections (SSIs), which cause a significant burden in terms of morbidity, mortality and healthcare costs, are infections of the incision site, organ or cavity that occur in the postoperative period. Compliance with surgical antimicrobial prophylaxis (SAP) is important to prevent SSI. The aim of this study was to compare the compliance of SAP use in the general surgery patients undergoing surgical procedures with the hospital protocol and the American Society of Health-System Pharmacists (ASHP) guideline and the compliance with the guideline in the process after the physicians were informed by the team including the clinical pharmacist post-training period (post-TP) with the due diligence pre-training period (pre-TP) regarding the prospective evaluation of the development of CAE in patients. Our study was conducted between January 24, 2022 and May 9, 2023 in the wards of the Department of General Surgery, Hacettepe University Hospitals in a total of 2 phases as pre-TP (n = 404) and post-TP (n = 406). Cefazolin is the most preferred agent for SAP, administered to 703 of 810 patients (86.8%). According to the ASHP guideline, the number of patients given the appropriate dose of cefazolin increased from 129 (41%) in pre-TP to 276 (92.6%) in post-TP (p <0.001), and the appropriate time of administration increased from 133 (42.2%) to 187 (62.8%) (p <0.001). The number of patients who received antibiotics while hospitalized in the ward in the postoperative period decreased in post-TP [85 (21%) and 58 (14.3%); p=0.012]. In pre-TP, 68 (16.8%) patients were prescribed antibiotics at discharge, while this rate decreased to 42 (10.3%) in post-TP (p=0.008). The rate of SSI development was 40 (9.9%) in pre-TP and 54 (13.3%) in post-TP (p=0.131). Involvement of clinical pharmacists in the multidisciplinary team of general surgery services and conducting routine trainings for surgeons due to their work overload is important in order to provide optimum patient monitoring and to improve SAP compliance rates.