Antibiotic administration in patients undergoing common surgical procedures in a community teaching hospital: The chaos continues

The influence of recently published guidelines by the Surgical Infection So ciety (SIS) on current surgical practice are not well documented. The appro priateness of antibiotic administration in a cohort of surgical patients un dergoing elective and emergency surgery in a department of surgery in an ur ban, community-based, private, 560-bed teaching hospital was retrospectivel y reviewed, The following were the criteria defining administration as appr opriate as modified from SIS guidelines: Prophylactic use: (1) started prio r to operation; (2) spectrum appropriate to the specific operation; (3) dur ation less than or equal to 24 hours, Therapeutic use: (1) started prior to operation; (2) spectrum appropriate to pathology; (3) Duration less than o r equal to 24 hours for contamination or "resectable" infection and less th an or equal to 5 days for established infection in the absence of clinical evidence of persisting infection. Any switchover from an appropriate agent to another appropriate or inappropriate agent in the same patient in the ab sence of microbiologic or clinical indication was considered inappropriate administration, We reviewed the charts of 211 randomly selected patients wh o underwent elective (n = 132) or emergency (n = 79) procedures during 1996 . The operations included gastrectomy (n = 22), appendectomy (n = 27), open (n = 5) or laparoscopic (n = 27) cholecystectomy, colectomy (n = 28), hyst erectomy (n = 8), laparotomy for intestinal obstruction (n = 11), mastectom y (n = 26), and ventral hernia repair (n = 37). A total of 17 antibiotics w ere used for prophylaxis and 21 for therapy, In 156 patients (74%) the admi nistration was considered inappropriate, Eight patients in the inappropriat e group developed diarrhea (two cases of Clostridium difficile-induced coli tis) compared to two cases of diarrhea in the appropriate group (nonsignifi cant). The average duration of administration after elective and emergency operations was 3.3 and 5.7 days, respectively. The total expense for excess ive duration of administration was $18,533, Many surgeons are not familiar with the spectrum of antimicrobials and often do not distinguish between pr ophylactic and therapeutic administration. Antibiotic usage in current surg ical practice is often inappropriate, excessive, and chaotic.