title: [Assessment of antibiotic use and impact of an intervention intended to modify the prescribing behavior in surgical prophylaxis in 6hospitals in the metropolitan area of Monterrey, Mexico].
abstract: BACKGROUND
  Improper use of antibiotics increases antimicrobial resistance.
  
  
  OBJECTIVE
  Evaluate the use of antibiotics and the impact of an intervention designed to improve antibiotic prescription for surgical prophylaxis in 6 hospitals of Monterrey, Mexico.
  
  
  METHODS
  Design: A prospective multicenter survey and a pretest-postest experimental study. Phase 1: Survey to evaluate the use of antibiotics through an especially designed guide. Phase 2: Intervention designed to improve antibiotic prescription for surgical prophylaxis by the medical staff by using printed, audiovisual and electronic messages. Phase 3: Survey to evaluate the impact of the intervention.
  
  
  METHODS
  Frequencies, percentages, medians, ranges and X2test.
  
  
  RESULTS
  Phase 1: We evaluated 358 surgical patients, 274 prophylactic antibiotic regimens. A total of 96% of antibiotics regimens began with inappropriate timing (290/302), 82.8% were inappropriate regimens (274/331), 77.7% were in inappropriate dosage (230/296), 86% of inadequate length (241/280), and in 17.4% restricted antibiotics were used (52/299). Phase 2: 9 sessions including 189 physicians (14 department chairs, 58 general practitioners and 117 residents). Phase 3: We evaluated 303 surgical patients, 218 prophylactic antibiotics regimens. Inappropriate treatment commencement was reduced to 84.1% (180/214) (P<0.001), inappropriate regimens to 75.3% (162/215) (P=0.03), inappropriate dosages to 51.2% (110/215) (P<0.001), and use of restricted antibiotics to 8.3% (18/215) (P=0.003).
  
  
  CONCLUSIONS
  Inappropriate use of prophylactic antibiotics in surgery is a frequent problem in Monterrey. The intervention improved the antibiotic prescription for surgical prophylaxis by reducing inappropriate treatment commencement, regimens, dosages, and overuse of restricted antibiotics. It is necessary to strengthen strategies to improve the prescription of antibiotics in surgical prophylaxis.
authors.affiliation: Unidad Médica de Alta Especialidad, Hospital de Especialidades N.° 25, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México. Electronic address: palsaugc@gmail.com.
authors.forename: Gerardo Del Carmen
authors.initials: GDC
authors.lastname: Palacios-Saucedo
authors.affiliation: Unidad Médica de Alta Especialidad, Hospital de Especialidades N.° 25, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México.
authors.forename: Mauricio
authors.initials: M
authors.lastname: de la Garza-Camargo
authors.affiliation: Unidad Médica de Alta Especialidad, Hospital de Ginecología y Obstetricia N.° 23, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México.
authors.forename: Evangelina
authors.initials: E
authors.lastname: Briones-Lara
authors.affiliation: Unidad Médica de Alta Especialidad, Hospital de Especialidades N.° 25, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México.
authors.forename: Sandra
authors.initials: S
authors.lastname: Carmona-González
authors.affiliation: Unidad Médica de Alta Especialidad, Hospital de Especialidades N.° 25, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México.
authors.forename: Ricardo
authors.initials: R
authors.lastname: García-Cabello
authors.affiliation: Hospital General de Zona N.° 33, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México.
authors.forename: Luis Arturo
authors.initials: LA
authors.lastname: Islas-Esparza
authors.affiliation: Hospital Christus-Muguerza de Alta Especialidad, Monterrey, Nuevo León, México.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saldaña-Flores
authors.affiliation: Hospital Christus-Muguerza de Alta Especialidad, Monterrey, Nuevo León, México.
authors.forename: Juan Roberto
authors.initials: JR
authors.lastname: González-Cano
authors.affiliation: Hospital San José, Tecnológico de Monterrey, Monterrey, Nuevo León, México.
authors.forename: Román
authors.initials: R
authors.lastname: González-Ruvalcaba
authors.affiliation: Hospital Metropolitano, Secretaría de Salud, Monterrey, Nuevo León, México.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Valadez-Botello
authors.affiliation: Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
authors.forename: Gerardo Enrique
authors.initials: GE
authors.lastname: Muñoz-Maldonado
authors.affiliation: Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Montero-Cantú
authors.affiliation: Coordinación de Unidad Médica de Alta Especialidad, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Ciudad de México, México.
authors.forename: Rita Delia
authors.initials: RD
authors.lastname: Díaz-Ramos
authors.affiliation: Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
authors.forename: Fortino
authors.initials: F
authors.lastname: Solórzano-Santos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D000073602:Antimicrobial Stewardship / Q000458:organization & administration*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000706:statistics & numerical data; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008800:Mexico; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011300:Preoperative Care; D015397:Program Evaluation; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis; Antibiotics; Antibióticos; Infección del sitio quirúrgico; Profilaxis antibiótica; Surgical site infection