title: Assessment of perioperative antimicrobial prophylaxis using ATC/DDD methodology.
abstract: OBJECTIVE
  In the light of international experience and guidelines and in order to improve the quality of perioperative antimicrobial prophylaxis (PAP), various hospitals have set up their own multidisciplinary healthcare teams and have evaluated the density of PAP through close supervision and interventions. The aim of the present study was to compare the density, quality, and cost of PAP before and after an intervention implemented at our hospital in order to increase the quality of PAP.
  
  
  METHODS
  PAP was monitored using a form prepared in line with the international guidelines, which was completed by the infection control nurse under the supervision of the infectious diseases specialist. In order to reduce the frequent errors in our PAP procedures, an intervention was implemented, and the period before this intervention (January-April 2011) was compared with the post-intervention period 1 year later (January-April 2012). The density of PAP was calculated according to the Anatomical Therapeutic Chemical classification/defined daily dose (ATC/DDD) methodology.
  
  
  RESULTS
  A total of 2398 patients received PAP during this period. The most frequently used antibiotic before and after the intervention was cefazolin. Its use further increased after the intervention (p<0.001). After the intervention, the ratio of the correct timing of the first antibiotic dose increased from 91.7% to 99.0% (p<0.001), while the excessively long administration of PAP was reduced from 77.0% to 44.7% (p<0.001). The ratio of full compliance with the guidelines increased from 15.5% to 40.2% (p<0.001) and the rate of surgical site infections dropped from 18.5% to 12.0%. The density of antibiotic use dropped from 305.7 DDD/100 procedures=3.1 DDD/procedure to 162.1 DDD/100 procedures=1.6 DDD/procedure.
  
  
  CONCLUSIONS
  The quality of PAP may be improved through better compliance with healthcare guidelines, close supervision, and training activities. Also, surgical site infections and the cost of PAP may be reduced through more appropriate antibiotic use, thus contributing to the national healthcare budget.
authors.affiliation: Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Dicle University, Yenişehir 21280, Diyarbakir, Turkey. Electronic address: drfatmayakut@hotmail.com.
authors.forename: Fatma
authors.initials: F
authors.lastname: Bozkurt
authors.forename: Safak
authors.initials: S
authors.lastname: Kaya
authors.forename: Serda
authors.initials: S
authors.lastname: Gulsun
authors.forename: Recep
authors.initials: R
authors.lastname: Tekin
authors.forename: Özcan
authors.initials: Ö
authors.lastname: Deveci
authors.forename: Saim
authors.initials: S
authors.lastname: Dayan
authors.forename: Salih
authors.initials: S
authors.lastname: Hoşoglu
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000191:economics / Q000379:methods; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000517:prevention & control*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: ATC/DDD index; Compatibility; Cost; Perioperative antimicrobial prophylaxis; Superintendence; Turkey