Antimicrobials to prevent infection in major surgery are used properly only about hal...( ophylaxis and current guidelines recom...),Health

ophylaxis, and current guidelines recommend dosing within one hour before incision.It is of interest that 9.6 percent of the patients in our assessment received their first dose more than four hours after incision when little if any benefit would be expected based on these previously published guidelines."

"Most (92.6 percent) of the patients in this assessment received a prophylactic antimicrobial regimen consistent with current guidelines," according to the study. "However, only 78.7 percent received regimens that were limited to the recommended agents, suggesting that a substantial amount of antimicrobials are used unnecessarily."

"The results of this study raise additional concerns regarding antimicrobial resistance. Our data suggest that vancomycin continues to be used excessively for surgical prophylaxis," the authors write. "In addition, 59.3 percent of patients received prophylaxis for more than 24 hours after the end of surgery." There is evidence that use of new, broad spectrum antimicrobials and prolonged use of antimicrobials can promote antimicrobial-resistant bacteria and increase the incidence of antibiotic-associated complications, according to the article.

"Substantial opportunities remain to improve the use of prophylactic antimicrobials for patients undergoing major surgery," the authors conclude. "Achieving high rates of performance for appropriate antimicrobial prophylaxis to prevent SSIs will require the development of systems in which the knowledge from years of research and recommendation from clinical practice guidelines are routinely incorporated into practice."

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Contact: Dale W. Bratzler
405-840-2891
JAMA and Archives Journals
21-Feb-2005

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