title: Compliance with guidelines on antibiotic prophylaxis in hip and knee arthroplasty in Italy: results of the GISIO-ISChIA project.
abstract: BACKGROUND
  The Perioperative Antibiotic Prophylaxis (PAP) contributes considerably to the total amount of antibiotics used in hospitals and has been shown to be associated with increase in antibiotic resistance and healthcare costs. The level of compliance with the national guidelines of current practices of PAP for elective hip and knee prosthesis procedures in a network of Italian hospitals (the multicentre Surgical Site Infection surveillance project GISIO-ISChIA), has been evaluated.
  
  
  METHODS
  Compliance of the current prophylactic antibiotic practices with the published national guidelines was assessed for each included operative procedure, considering indication, timing of administration, prescribed antimicrobial agent and total duration of prophylaxis.
  
  
  RESULTS
  A total of 14 hospitals and 1285 surgical procedures were included. 99.4% of patients received antimicrobial prophylaxis pre-operatively and 73.0% of patients received PAP within the recommended time period (within 60 minutes before incision). The rate of compliance with discontinuation of PAP within 24 hours after initiation of surgery was 70.2%. Taking into account all doses administered, the antibiotic was chosen appropriately in 57.7% of patients. PAP was performed appropriately, in accordance with national guidelines, in 43.6% of surgical operations.
  
  
  CONCLUSIONS
  Given the increasing number of replacement procedures in Italy and in Europe, the gap between the evidence-based guidelines and practice must be appropriately addressed in order to improve PAP practices.
authors.affiliation: Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Agodi
authors.affiliation: Department of Biomedical Sciences for Health, University of Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Auxilia
authors.affiliation: Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Barchitta
authors.affiliation: Department of Health Sciences, University of Genoa, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Cristina
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Italy.
authors.forename: Ida
authors.initials: I
authors.lastname: Mura
authors.affiliation: Department of Biomedical Sciences for Health, University of Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Nobile
authors.affiliation: Department of Biomedical Biotechnological and Translational Sciences, University of Parma, Italy.
authors.forename: Cesira
authors.initials: C
authors.lastname: Pasquarella
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D017410:Practice Guidelines as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Duration; Orthopedic surgery; Perioperative antibiotic prophylaxis; Timing