Background and Importance Surgical antibiotic prophylaxis in orthopaedic joint arthroplasties is common reason for unnecessary, excessive and irresponsible use of antibiotics.

Aim and Objectives The purpose of this study was to analyse whether the continuous presence of clinical pharmacist on the ward may improve SAP guidelines adherence and clinical outcomes.

Material and Methods The study was conducted at an Orthopaedics Department of a tertiary care medical centre. Overall guideline adherence (agent, dose, frequency, duration), clinical outcomes (length of stay-LOS, number of surgical site infections-SSIs), antibiotic exposure and direct antibiotic costs were compared between pre-intervention (retrospective observational) and intervention (prospective) periods. The clinical pharmacist’s interventions consisted of proactively controlling antibiotic prophylaxis every day on an individual level to ensure compliance with SAP (agent selection, dosage, and duration) guidelines, attending surgical ward visits, participating in antibiotic related decisions, and providing continuous counselling service. SAP guideline adherence, antibiotic exposure, and costs in the two periods were compared using Chi-square, Fisher exact, and Mann-Whitney tests.

Results Significant improvement in overall SAP guideline adherence (by 56.2%, from 2% to 58.2%, p<0.001) was observed. Significant reduction in SAP duration (by 42.9%, 4.1 ± 2.1 vs 2.1 ± 1.9 days, p<0.001), in SAP antibiotic exposure (by 41%, from 6.1 ± 0.05 to 3.6 ± 4.3 DDD/patient, p<0.001), and average prophylactic antibiotic cost (by 54.8%, 9278.8 ± 6094.3 vs 3598.2 ± 3354.6 HUF/patient) were observed. Moreover, prolonged prophylaxis has no benefit on clinical outcomes (LOS: decreased by 37.2%, 11.2 ± 7 to 7.62 ± 3 days, p<0.001; confirmed SSIs: deceased by 1.8%, from 3% to 1.2%, p=0.21).

Conclusion and Relevance Continuous presence of the clinical pharmacist is crucial in optimising antibiotic use. Pharmacist’s intervention led to a significant improvement in SAP guideline adherence, that entailed also the significant reduction of antibiotic exposure, length of stay, and costs. Additional research, focusing on empirical and targeted antibiotic therapy and implementation of optimising antibiotic use, is needed.

References and/or Acknowledgements 1. Fesus, A., et al. The Effect of Pharmacist-Led Intervention on Surgical Antibacterial Prophylaxis (SAP) at an Orthopedic Unit. Antibiotics (Basel), 2021: 10(12) doi.org/10.3390/antibiotics10121509

Conflict of Interest No conflict of interest