Use and abuse of surgical antibiotic prophylaxis in hospitals in Taiwan

Background and purpose: A large proportion of antibiotics used in hospitals is for surgical prophylaxis. We determined the prevailing practices and fa ctors associated with the misuse of surgical antibiotic prophylaxis in hosp itals in Taiwan. Methods: In a systematic survey of the medical records of 629 patients from 14 hospitals who underwent clean or clean-contaminated surgery from Septem ber 1998 through March 1999, data on the timing and duration of, and reason s for, antibiotic use were collected and analyzed. Results: Overall, 578 (92%) patients received antibiotics perioperatively; in 499 (79%) cases, antibiotics were used for surgical prophylaxis. Only 30 2 (61%) patients received prophylaxis within 1 hour before surgery. More th an 70% of patients received more than 3 days of postoperative antibiotic pr ophylaxis. The most commonly used antibiotics were first-generation cephalo sporins and aminoglycosides. Factors independently associated with inapprop riately timed prophylaxis included surgery performed at a hospital with a g reater proportion of intensive care unit beds (conditional odds ratio [OR] = 1.14 per 1% increase, 95% confidence interval [CI95%] 1.06-1.23; p < 0.01 ), surgery duration of at least 1 hour (OR = 0.40, CI95% 0.24-9.67; p < 0.0 1), orthopedic surgery (OR = 0.59, CI95% 0.36-0.98; p = 0.041), and cardiot horacic surgery (OR = 2.07, CI95% 1.14-3.77; p = 0.02). Risk factors for mo re than 3 days of prophylaxis included surgical placement of prosthetic mat erial (OR = 2.26, CI95% 1.10-4.64; p = 0.03), the number of antibiotics use d (OR = 1.99 per antibiotic, CI95% 1.26-3.13; p < 0.01), surgery duration o f at least 1 hour (OR = 3.07, CI95% 1.45-6.51; p < 0.01), neurosurgery (OR = 4.57, CI95% 2.24-9.31; p < 0.01), and the use of oral antibiotics togethe r with intravenous drugs (OR = 20.72, CI95% 10.72-40.07; p < 0.01). Conclusions: The results of this survey indicate that inappropriate use of surgical antibiotic prophylaxis is common in hospitals in Taiwan. Our resul ts identify several problem areas, including incorrect timing, duration, an d use of oral antibiotics for surgical prophylaxis, that require targeted p hysician education and public health interventions.