Patterns of antimicrobial use in the neurosurgical ward of Kenyatta National Hospital
Abstract
Background: Antibiotics in neurosurgery are used for prophylaxis and treatment of already established infection. Guidelines state that prophylactic antibiotics should be given for up to 24 hours. For treatment of already established infections, empiric therapy with intravenous antibiotics for four to eight weeks is indicated. Studies have shown no distinction between antibiotic use for prophylaxis and treatment of established infection in neurosurgery.
Objectives: To identify antibiotic use patterns and medication errors and their association with development of surgical site infections.
Methods: A prospective cohort study involving adult neurosurgical patients was carried out at Kenyatta National Hospital, between April 2015 and July 2015. Patient demographic data as well as data on surgical procedures carried out, antibiotics used and medication errors was collected. Descriptive data analysis was done for all variables. To test for association between antibiotic use patterns and development of surgical site infections, the Fischer exact Chi square test was used.
Results: Out of the 84 participants recruited in the study, 87.2% (n=68) used antibiotics. Ceftriaxone was the most commonly used (63.7%, n= 44), followed by metronidazole (40.4%, n=23). Medication errors that were noted involved inappropriate choice and use of antibiotics. There was no distinction between use of antibiotics for prophylaxis and treatment of infection. There was no statistically significant association between patterns of antibiotic use and development of surgical site infection.
Conclusion: Antibiotic use patterns do not affect the incidence of neurosurgical site infections. Prescribing errors of various types were prominent. An antibiotic use protocol should guide antimicrobial selection and use in neurosurgery.
Key words: antibiotic, prophylaxis, medication errors
References
American Society for Health System Pharmacists Therapeutic Guidelines (2016). Clinical Practice guidelines for antimicrobial prophylaxis in surgery. www.ashp.org. Accessed 13/05/2016.
Apostolopoulou E, Dimitros Z and Aikaterini G (2016). The impact of irrational perioperative antimicrobial prophylaxis on the nursing workload. Health Sci. J. www.hsj.gr. Accessed 15/05/2016.
Bond CA and Raehl CL (2007). Clinical and economic outcomes of pharmacist-managed antimicrobial prophylaxis in surgical patients. Am. J. Health Syst. Pharm. 64: 1935-1942.
Bozkurt F, Kaya S and Gulsun S (2013). Assessment of perioperative antimicrobial prophylaxis using ATC DDD Methods. Int. J. Infect. Dis. 17:e1212-e1217.
Brook I (2015). Brain abscess treatment and management. Medscape. http://reference.medscape.com/article/212946-treatment. Accessed 26/05/2016.
Collins S (2013). SSI prevention: crossing environments of care, standardizing incision management. Infect. Control Today; www.infectioncontroltoday.com. Accessed 14/5/2016.
Daniel W.W. (2010). Biostatistics: Basic concepts and Methodology for the health sciences. 9th Edition, John Wiley and Sons, Inc. Wiley India (P), New Delhi, India.
European Medicines Agency (2015). Medication errors. www.ema.europa.eu. Accessed 6/6/2016.
Gouvea M, Novaes CO and Pereira D (2015). Adherence to guidelines for surgical antimicrobial prophylaxis: a review. Braz. J. Infect. Dis. 19:517-524.
Ha J-S, Oh S-M and Kang J-H (2012). Efficacy of short term versus long term antimicrobial prophylaxis for preventing surgical site infections after clean neurosurgical operations. Korean J. Neurotrauma. 8:104-109.
Hammad MA, Al-Akhali KM and Mohammed AT (2013). Evaluation of surgical antimicrobial prophylaxis in Aseer Area hospitals in the Kingdom of Saudi Arabia. JPCS. 6:1-7.
Hawn MT, Richman JS and Vick CC (2013). Timing of surgical antimicrobial prophylaxis and the risk of surgical site infection. JAMA Surg. 148: 649-657.
Jiang X, Jianjun MA and Hou F (2016). Neurosurgical site infection prevention: single institute prevention. Turkish Neurosurg. 26: 234-239.
Junker T, Mugajic E and Hoffmann H (2012). Prevention and control of surgical site infections: review of the Basel Cohort Study. Swiss Medical Weekly. 142: w13616.
Lorensia A, Wahjuninasih E and Wijokongko G (2012). Study of drug related problems in the use of antimicrobial prophylaxis for appendectomy in a hospital in Sidowjo. A Conference presentation at the Federation of Asian Pharmaceutical Association, Bali, Indonesia. www.researchgate.net. Accessed 14/05/2016.
Lundine KM, Nelson S and Duffy PJ (2010). Adherence to perioperative antimicrobial prophylaxis among orthopaedic trauma patients. Can. J. Surg. 53:367-372.
Ozgun H, Ertugul BM and Soyder A (2010). Perioperative antimicrobial prophylaxis: adherence to guidelines and effects of educational intervention. Int. J. Surg. 8:159-163.
Sharma MS, Suri A and Chandra SP (2012). Cost and usage patterns of antibiotics in a tertiary care neurosurgical unit. Indian J. Neurosurg. 1:41-47.
Testa M, Stillo M and Giacomelli S (2015). Appropriate use of antimicrobial prophylaxis: an observational study in 21 surgical wards. BMC Surg. 15:63.
Ulu- Kilic A, Alp E and Cevahir F (2015). Economic evaluation of appropriate duration of antimicrobial prophylaxis for prevention of neurosurgical infections in a middle income country. Am. J. Infect. Control. 43: 44-47.
WHO Collaborating Centre for Drug Statistics and Methods (2016). ATC DDD Classification for Anti-infectives. WHOCC-ATC/DDD index. www.whocc.no/atc_ddd_index/?code. Accessed 8/6/2016.
Full Text: PDF
Refbacks
- There are currently no refbacks.