Background An antibiotic stewardship programme was set up recently in the University Hospital.
As a first step we intended to assess antibiotic use and identify problematic areas.
Purpose The aim of the present study is to map antibiotic use in a tertiary care surgical unit.
Material and methods Data was collected on systemic antibiotics delivered from the central pharmacy to the department between 2010 and 2017. Antibiotics were classified according to the Anatomical Therapeutic Chemical index. Consumption was analysed by the WHO Defined Daily Dose (DDD) method, considering the new DDDs assigned and valid from January 2019. Consumption data in DDD was standardised for 100 patient-days. Quality was assessed by the DU90 method.
Results The antibiotic use of the surgical department was more than 20,000 DDDs each year with no particular trend in use, and in different years it was responsible for 14.5% and 16.8% of total systemic antibiotic use of the university. The total antibiotic use in DDD/100 patient-days has decreased by 10% (from 80.7 to 72.0 DDD/100 patient-days), but mainly because of the increase in patient-days.
Mainly parenteral agents were used and this trend creeped up gradually (2010: 56.3%, 2017: 68.0%). Ten antibacterial agents were responsible for the DU90% segment in 2010 and nine in 2017. Metronidazole and cefuroxime (routinely administered for 2 days as surgical antibiotic prophylaxis in the study period) headed the top list in each year and they were responsible for 50% or more of total antibiotic use during the whole study period. Cefazolin use was very low despite the fact that it was the recommended first-line agent in combination with metronidazole for colorectal surgeries. Narrow spectra beta-lactamase-sensitive penicillin use was also marginal (below 1 DDD/100 patients-days).
Conclusion Our study showed a decrease in standardised antibiotic exposure but quality indicators revealed some suboptimal pattern (homogenous antibiotic use, lack of narrow spectra penicillin use, low use of recommended agents (e.g. cefazolin)). Stewardship intervention – aiming to further decrease antibiotic quantity – should first target the surgical antibiotic prophylaxis, while specific intervention should be implemented to optimise the pattern of antibiotic use.
References and/or acknowledgements EAHP Position Paper on Antimicrobial Resistance (AMR).
No conflict of interest.
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