Appropriateness of antibiotic prophylaxis for major surgery in Korea.
OBJECTIVE
To determine the appropriateness of antibiotic prophylaxis regimens for major surgery in Korea.


METHODS
Retrospective study using a written survey for each patient who underwent arthroplasty, colon surgery, or hysterectomy.


METHODS
Six tertiary hospitals in Seoul and Gyeonggi Province.


METHODS
From each hospital, a maximum of 150 patients who underwent each type of surgery were randomly chosen for the study.


RESULTS
Of 2,644 eligible patients, 1,914 patients were included in the analysis; 677 of these patients underwent arthroplasty, 578 underwent colon surgery, and 659 underwent hysterectomy. Nineteen patients were excluded from the analyses of the class and number of antibiotics used for prophylaxis because they underwent multiple surgeries at different sites. For each of the 1,895 remaining patients, antibiotic prophylaxis involved a mean (+/-SD) of 2.8 +/- 0.9 classes of antibiotics. The most commonly prescribed agents were cephalosporins (prescribed for 1,875 [98.9%] of the patients) and aminoglycosides (1,404 [74.1%]). A total of 1,574 (83.1%) of patients received at least 2 classes of antibiotics simultaneously. Only 15 (0.8%) of 1,895 patients received antibiotic prophylaxis in accordance with published guidelines. Of 506 patients for whom the initial dose of antibiotics was evaluated, 374 (73.9%) received an appropriate initial dose. Of the 1,676 patients whose medical records included information about antibiotic administration relative to the time of surgery, only 188 (11.2%) received antibiotic prophylaxis an hour or less before the surgical incision was made. Of the 1,748 patients whose medical records included information about duration of surgery, antibiotic prophylaxis was discontinued 24 hours or less after surgery for only 3 (0.2%) of the patients.


CONCLUSIONS
Most patients who had major surgery in Korea received inappropriate antibiotic prophylaxis. Measures to improve the appropriateness of antibiotic prophylaxis are urgently required.
Choi
Won Suk
WS
Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Song
Joon Young
JY
Hwang
Jung Hae
JH
Kim
Nam Soon
NS
Cheong
Hee Jin
HJ
D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001178:Arthroplasty; D013505:Digestive System Surgical Procedures; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy; D007723:Korea; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies