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Compliance With Guidelines on Antibiotic Prophylaxis in Total Hip Replacement Surgery: Results of a Retrospective Study of 416 Patients in a Teaching Hospital

Published online by Cambridge University Press:  02 January 2015

Pierrick Bedouch ,
José Labarère ,
Emmanuel Chirpaz ,
Benoit Allenet ,
Alain Lepape ,
Magali Fourny ,
Patricia Pavese ,
Pierre Girardet ,
Philippe Merloz  and
Dominique Saragaglia
...Show all authors
Pierrick Bedouch
Affiliation:
Unité devaluation Médicale, DMAS
José Labarère*
Affiliation:
Unité devaluation Médicale, DMAS
Emmanuel Chirpaz
Affiliation:
Unité devaluation Médicale, DMAS
Benoit Allenet
Affiliation:
Département de Pharmacie, DMAS
Alain Lepape
Affiliation:
Service d'Anesthésie-Réanimation, Centre Hospitalier Universitaire, Lyon, France
Magali Fourny
Affiliation:
Unité devaluation Médicale, DMAS
Patricia Pavese
Affiliation:
Service de Médecine Interne et Maladies Infectieuses, DMAS
Pierre Girardet
Affiliation:
Département d'Anesthésie-Réanimation, Centre Hospitaller Universitaire de Grenoble, France
Philippe Merloz
Affiliation:
Service de Chirurgie Orthopédique Nord, Centre Hospitaller Universitaire de Grenoble, France
Dominique Saragaglia
Affiliation:
Service de Chirurgie Orthopédique Sud, Centre Hospitaller Universitaire de Grenoble, France
Jean Calop
Affiliation:
Département de Pharmacie, DMAS
Patrice Francois
Affiliation:
Unité devaluation Médicale, DMAS
*
Unite d'Evaluation Medicate, Pavilion D, CHU-BP 217, 38 043 Grenoble cedex 9, France
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Abstract

Objective:

To assess compliance of anesthesiologist practices in antibiotic prophylaxis during total hip replacement (THR) surgery with the French Society of Anesthesiology and Intensive Care consensus-based guidelines.

Design:

Retrospective review of medical records. Compliance of anesthesiologist practices with the guidelines was assessed according to antibiotic prophylaxis use, antimicrobial agent, dosage of first injection, time from first dose to incision, and total duration of antibiotic prophylaxis.

Setting:

Orthopedic surgery wards in a 2,200-bed French teaching hospital.

Patients:

A random sample of 416 patients undergoing THR from January 1999 to December 2000.

Results:

Three hundred eighty-six (93%) of the sampled medical records were usable. Antibiotic prophylaxis was used for 366 (95%) of the patients. Total duration of prophylaxis did not exceed 48 hours in 98% (359 of 366) of the patients. Drug selection complied with national guidelines in 259 (71%) of the patients. Dosage and timing of the first injection were appropriate in 98% (290 of 296) and 80% (236 of 296) of the patients, respectively, who received one of the recommended antibiotics. Overall, 53% (203 of 386) of the patients met all five criteria. In multivariate analysis, there was a significant anesthesiologist effect on overall compliance with the guidelines (likelihood ratio chi-square with 9 degrees of freedom, 25.7; P < .01). Undergoing surgery during 2000 was the only patient characteristic associated with an increased rate of appropriate practices (adjusted OR, 1.56; CI95,1.02-2.38).

Conclusion:

The overall compliance rate should be improved by disseminating the guidelines and the results of this study following audit and feedback.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 4 , April 2004 , pp. 302 - 307
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Malchau, H, Herberts, P, Ahnfelt, L. Prognosis of total hip replacement in Sweden: follow-up of 92,675 operations performed 1978-1990. Acta Ortkop Scand 1993;64:497–506.CrossRefGoogle Scholar
2.Garellick, G, Malchau, H, Herberts, P, Hansson, E, Axelsson, H, Hansson, T. life expectancy and cost utility after total hip replacement. Clin Orthop 1998;(346):141–151.Google ScholarPubMed
3.Hoaglund, FT, Steinbach, LS. Primary osteoarthritis of the hip: etiology and epidemiology. J Am Acad Orthop Surg 2001;9:320–327.CrossRefGoogle Scholar
4.Glenny, A, Song, F. Antimicrobial prophylaxis in total hip replacement: a systematic review. Health Technol Assess 1999;3:1–57.CrossRefGoogle ScholarPubMed
5.Agence Nationale d'Accréditation et devaluation en Santé. Assessing Clinical Practices in Antibiotic Prophylaxis: The Example of Total Hip Replacement [in French]. Paris: Agence Nationale d'Accréditation et devaluation en Sante; 2000.Google Scholar
6.Sasse, A, Mertens, R, Sion, JP, et al.Surgical prophylaxis in Belgian hospitals: estimate of costs and potential savings. J Antimicrob Chemother 1998;41:267–272.CrossRefGoogle ScholarPubMed
7.Gillespie, WJ, Walenkamp, G. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures (Cochrane Review). Cochrane Database Syst Rev 2001;1:CD000244.Google Scholar
8.Lortat-Jacob, A. Antibiotic prophylaxis in orthopedic surgery [in French]. Ann Fr Anesth Reanim 1994;13:S51–S60.CrossRefGoogle ScholarPubMed
9.Société Française d'Anesthésie et de Réanimation. Guidelines for antibiotic prophylaxis surgery: update 1999 [in French]. Médecine et Maladies Infectieuses 1999;29:435–445.Google Scholar
10.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20:250–278.CrossRefGoogle ScholarPubMed
11.Donner, A, Klar, N. Methods for comparing event rates in intervention studies when the unit of allocation is a cluster. Am J Epidemiol 1994;140:279–289.CrossRefGoogle Scholar
12.Hosmer, D, Lemeshow, S. Applied Logistic Regression, ed. 2. New York: John Wiley & Sons; 2000.CrossRefGoogle Scholar
13.Finkelstein, R, Reinhertz, G, Embom, A. Surveillance of the use of antibiotic prophylaxis in surgery. Israel Journal of Medical Sciences 1996;32:1093–1097.Google ScholarPubMed
14.Kurz, X, Mertens, R, Ronveaux, O. Antimicrobial prophylaxis in surgery in Belgian hospitals: room for improvement. Eur J Surg 1996;162:15–21.Google Scholar
15.Ronveaux, O, Mertens, R, Jans, B, Dupont, Y. Methods in surgical antibacterial prophylaxis in Belgium, 1992-1995 [in French]. Acta Clin Belg 1996;51:386–394.CrossRefGoogle ScholarPubMed
16.Silver, A, Eichorn, A, Krai, J, et al.Timeliness and use of antibiotic prophylaxis in selected inpatient surgical procedures. Am J Surg 1996;171:548–552.CrossRefGoogle ScholarPubMed
17.Zoutman, D, Chau, L, Watterson, J, Mackenzie, T, Djurfeldt, M. A Canadian survey of prophylactic antibiotic use among hip-fracture patients. Infect Control Hosp Epidemiol 1999;20:752–755.CrossRefGoogle ScholarPubMed
18.Jogerst, GJ, Dippe, SE. Antibiotic use among medical specialties in a community hospital. JAMA 1981;245:842–846.CrossRefGoogle Scholar
19.Chassin, MR, Brook, RH, Park, RE, et al.Variations in the use of medical and surgical services by the Medicare population. N Engl J Med 1986;314:285–290.CrossRefGoogle ScholarPubMed
20.Chassin, MR, Kosecoff, J, Park, RE, et al.Does inappropriate use explain geographic variations in the use of health care services? A study of three procedures. JAMA 1987;258:2533–2537.CrossRefGoogle ScholarPubMed
21.United States Pharmacopeial Convention. Drug Information for the Health Care Professional, ed. 19. Englewood, NJ: Micromedex; 1999.Google Scholar
22.Perl, TM, Roy, MC. Postoperative wound infections: risk factors and role of Staphylococcus aureus nasal carriage. J Chemother 1995;7:29–35.Google ScholarPubMed
23.Girou, E, Azar, J, Wolkenstein, P, Cizeau, F, Brun-Buisson, C, Roujeau, JC. Comparison of systematic versus selective screening for methicillin-resistant Staphylococcus aureus carriage in a high-risk dermatology ward. Infect Control Hosp Epidemiol 2000;21:583–587.CrossRefGoogle Scholar
24.Lefflot, S, Lesquelen, A, Blot, P, Fauvelle, F. Surgical antibiotic prophylaxis: point evaluation of practices [in French]. Pathol Biol (Paris) 1999;47:1071–1074.Google ScholarPubMed
25.Martin, C, Viviand, X, Gayte-Sorbier, A, Saux, MC. Survey of 39 South East Group hospital centers on the practice of antibiotic prophylaxis in surgery [in French]. Ann Fr Anesth Reanim 1998;17:764–768.CrossRefGoogle Scholar
26.Classen, DC, Evans, RS, Pestotnik, SL, Horn, SD, Menlove, RL, Burke, JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281–286.CrossRefGoogle ScholarPubMed
27.Harbarth, S, Samore, MH, Lichtenberg, D, Carmeli, Y. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation 2000;101:2916–2921.CrossRefGoogle ScholarPubMed
28.Davies, HT, Crombie, IK. Assessing the quality of care. BMJ 1995;311:766.CrossRefGoogle ScholarPubMed
29.Gyssens, IC, Knape, JT, Van Hal, G, ver der Meer, JW. The anaesthetist as determinant factor of quality of surgical antimicrobial prophylaxis: a survey in a university hospital. Pharm World Sci 1997;19:89–92.CrossRefGoogle ScholarPubMed
30.Oxman, AD, Thomson, MA, Davis, DA, Haynes, RB. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ 1995;153:1423–1431.Google ScholarPubMed