title: DRUGS system enhancing adherence of Chinese surgeons to antibiotic use guidelines during perioperative period.
abstract: OBJECTIVE
  Irrational use of antimicrobial agents for preventing postoperative SSIs is a common phenomenon in China, which results in more bacterial resistance, higher hospital infection rates, extra costs of antimicrobial agents. The aim of the study is to evaluate the effect of Drug Rational Usage Guidelines System (DRUGS) on the surgeon's prescription behavior of antimicrobial agents.
  
  
  METHODS
  10 common surgical operations which included 1543 cases (where 778 cases using paper-based guidelines and 765 cases using DRUGS) were selected and their demographic and clinical data were collected. The selected operations include thyroid resection, breast mass resection, myomectomy, etc. The evaluation criteria were antibiotic administrative categories, the time of initial dose, duration of administration, length of stay, the costs of antibiotics, SSIs and drug adverse reactions(ADR).
  
  
  RESULTS
  The antimicrobial agents were mostly administrated within 0.5 h to 2 h before incision, 656 patients (85.75%) were intervened with DRUGS and 256 (32.90%) with paper-based guidelines according to the protocol. For the clean wounds incision, 547 patients (91.62%) were within 24 h of withdrawal antibiotics with using paper-based guidelines versus 91 (14.79%) with using DRUGS. A total of 19 kinds of antibiotics were used in the 1543 cases. The leading three on the list of frequency were piperacillin and sulbactam sodium, cefathiamidine and cefoperazone. While after the intervention, the list of frequency changed to cefazolin, cefathiamidine, cefoperazone. The average hospital stay was (7.00±4.31)d with paper-based guidelines and (2.54±1.57)d with DRUGS, respectively. The average cost of antibiotics was ¥(3481.36±2584.46) with paper-based guidelines and ¥(1693.39±1478.27) with DRUGS, respectively. However, there were no significant differences in the incidence of SSIs and ADR between two groups.
  
  
  CONCLUSIONS
  In this study, the increased availability of antibiotic guidelines at the time of drug ordering, combined with DRUGS, was associated with an enhanced surgeon adherence to guidelines.
authors.affiliation: Department of Pharmacy, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
authors.forename: Zhifu
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Pharmacy, Shaanxi Province Tumor Hospital, Xi'an, Shaanxi, People's Republic of China.
authors.forename: Peixi
authors.initials: P
authors.lastname: Zhao
authors.affiliation: Department of Pharmacy, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
authors.forename: Jingwen
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Medical Affair, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
authors.forename: Liping
authors.initials: L
authors.lastname: Tong
authors.affiliation: Department of Pharmacy, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
authors.forename: Jinyi
authors.initials: J
authors.lastname: Cao
authors.affiliation: Department of Pharmacy, Shaanxi Province Tumor Hospital, Xi'an, Shaanxi, People's Republic of China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Department of Medical Affair, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
authors.forename: Zhanpeng
authors.initials: Z
authors.lastname: Yao
authors.affiliation: Department of Medical Affair, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
authors.forename: Jingbo
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Pharmacy, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
authors.forename: Yanrong
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Pharmacy, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Jia
authors.affiliation: Department of Pharmacy, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
authors.forename: Aidong
authors.initials: A
authors.lastname: Wen
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002681:China; D005260:Female; D019983:Guideline Adherence; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D066231:Surgeons; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents