[Evaluation of antibiotic prophylaxis for hip and knee replacement: a multicentered study in Aquitaine public and private hospitals (SouthWestern France)].
OBJECTIVE
The aim of the study was to estimate the prescription and administration of antibioprophylaxis for hip and knee replacement in Aquitaine (SouthWestern France).


METHODS
In 2003, "Social Security" medical experts performed a descriptive and retrospective study on a sample of scheduled surgical operations in all the Aquitaine public and private hospitals. Antibioprophylaxis, protocols, and practice were assessed by studying the patients' medical files. The analysis was made on adjusted numbers to take into account the size of every institution.


RESULTS
In 51 hospitals, 58.8% of antibioprophylaxis protocols followed French guidelines. The sample corresponded to an adjusted number of 9,651 patients. Antibiopropylaxis was prescribed for 99.3% of patients, the course of antibioprophylaxis followed guidelines for 77.4% of the patients, the choice of the molecule and the dosage in 85.4% of the cases. Interval between antibiotic injection and surgical section was the main criterion of nonconformity (56.3%); it was under30 minutes for 43.7% of cephalosporin injections. In the post-operative period, administration complied with the medical prescription for 76.4% of the patients and dosage was adapted for 60.0% of the patients. According to the studied variables, 3 to 23.5% of data was missing in the medical files.


CONCLUSIONS
If the quality of care and practice must be improved, it is mandatory to implement written and confirmed antibioprophylaxis protocols, to better document medical files, to insure an improved coordination among professionals before, during, and after surgery.
Maury
B
B
Service Médical d'Aquitaine, Echelon de Pau, Cnamts, 26 bis, avenue des Lilas, BP 9095, 64051 Pau Cedex 09, France. benedicte.maury@elsm-pau.cnamts.fr
Dupon
C-D
CD
Dupon
M
M
Labat
A
A
Kosellek
D
D
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods* / Q000592:standards; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005602:France; D006801:Humans; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012424:Rural Population; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014505:Urban Population
D000900:Anti-Bacterial Agents