Educational Antimicrobial Stewardship Intervention Ineffective in Changing Surgical Prophylactic Antibiotic Prescribing

Abstract

Background: High rates of inappropriate use of prophylactic antibiotics in surgery continue to be reported in the literature, with many institutions designing interventions aimed at improving prescription. This study evaluates the surgical arm of a clinician-focused educational antimicrobial stewardship program implemented in February 2014 at Blacktown Hospital, Australia.

Methods: A before-after analysis of the surgical antibiotic prophylaxis intervention was conducted at Blacktown Hospital, New South Wales, Australia. Two hundred abdominal general surgical patients were selected via simple random sampling and categorized into pre-intervention (n = 100) and post-intervention (n = 100) groups. Antibiotic prophylaxis regimens were compared with the Australian guideline, Therapeutic Guidelines: Antibiotic (v14) with respect to drug choice, dosage, timing of administration, and duration of administration.

Results: Overall adherence rates in the pre- and post-intervention periods were 18% and 15% respectively, demonstrating no substantial change (p = 0.568). No patients in either group were administered antibiotics without an appropriate indication. There were no substantial decreases in error rates across any category, including drug choice, dosage, timing of administration, duration of administration, or re-dosing. The apparent decrease in the rate of inappropriate broad-spectrum cephalosporin usage was not statistically significant (29.3% vs. 18.8%; p = 0.16).

Conclusions: The educational intervention studied demonstrated no substantial change to overall adherence. Given the frequent failure of such interventions, stronger and more directly mandated adoption of prescribing guidelines is recommended for surgical services. Future consideration should be given to focused computer-based solutions, integrated with electronic medical records where possible.