Antibiotic prophylaxis in gastroduodenal surgery.
OBJECTIVE
In a retrospective process quality control trial, proper use of antimicrobial prophylaxis in gastroduodenal operations according to the standard guidelines was studied.


METHODS
A total of 132 consecutive adult patients (pts), who underwent gastroduodenal surgery in a University Hospital, were enrolled to this study protocol. There were 88 males and 44 females of with mean (+/-SD) age of 58.7 (+/-9.1) years old. The patients were divided into 4 groups based on surgical antibiotic prophylaxis policy. Group A consisted of surgical pts receiving appropriate antibiotic prophylaxis (a 2nd generation cephalosporin) when there was indication. Group B consisted of pts without indication who did not receive prophylaxis, Group C pts who, although antibiotic prophylaxis was indicated, were not given prophylaxis, and Group D pts without indication who received prophylaxis.


RESULTS
Of 132 pts examined, appropriate antibiotic prophylaxis was received by 28 pts (21%) (Group A). In 62 pts (47%), antibiotic prophylaxis was not indicated and not administered (Group B). On the contrary, in 42 pts (32%), although antibiotic prophylaxis was indicated, it was not given (Group C). No patient received prophylaxis without indication. The following infections were found: wound infection (n = 10), pneumonia (n = 6), severe sepsis (n = 2), urinary tract infection (n = 2), and fever of unknown origin (n = 2). Where correct antibiotic prophylaxis policy was followed (Groups A and B), 6 post-operative infections occurred (6.7%), with a mean (+/-SD) hospital length of stay 14.4 (+/-3.2) days. In contrast, in the group with incorrect antibiotic prophylaxis policy (group D), 16 infectious complications occurred (38%) (p = 0.001), with a mean (+/-SD) hospital length of stay 22.5 (+/-4.4) days (p = 0.001). Total hospitalization costs were much higher in this group compared with Groups A and B (p = 0.01). Mortality rate was 9.5% in Group D, while no deaths occurred in the other groups (p = 0.01).


CONCLUSIONS
Antimicrobial prophylaxis policy is an important issue, targeting lower morbidity or avoidable costs.
Schilling
J
J
Department of Surgery, University Hospital Zürich, Switzerland.
Michalopoulos
A
A
Geroulanos
S
S
D000368:Aged; D019072:Antibiotic Prophylaxis; D004378:Duodenal Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000601:surgery*; D013530:Surgical Wound Infection / Q000517:prevention & control