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N Z Med J. 2018 May 18;131(1475):35-43.

Inappropriate prescribing of antibiotics following discharge after major surgery: an area for improvement.

Author information

1
Clinical Microbiologist, Department of Microbiology, Auckland City Hospital, Auckland.
2
Evaluation Manager, New Zealand Health Quality & Safety Commission, Wellington.
3
Antimicrobial Stewardship Pharmacist, Adult Infectious Diseases Service, Auckland City Hospital, Auckland.

Abstract

AIM:

This study aims to determine the indications for antibiotic use in patients discharged following major surgery at Auckland City Hospital (ACH); to determine if the indications were appropriate and to identify opportunities where antimicrobial stewardship interventions would be beneficial.

METHODS:

This was a retrospective study of adult patients who were dispensed an antibiotic within the first two days of discharge after major surgery at ACH between 1 January 2013 and 31 December 2013. The indication for antibiotic use was determined and subsequently classified as either 'appropriate', 'not assessable' or 'inappropriate'.

RESULTS:

Among the 378 patients analysed, an indication for antibiotic use was not documented in 52 patients (13.8%). Antibiotics were prescribed for an established infection in 172 patients (45.5%), as empiric therapy in 100 patients (26.4%), and as prolonged surgical antimicrobial prophylaxis in 41 patients (10.8%). Overall, nearly half of the antibiotic courses dispensed (48.7%) were either 'inappropriate' or the indication was 'not assessable'.

CONCLUSIONS:

This study demonstrates that a significant proportion of antibiotics prescribed in patients discharged following surgery are inappropriate and there is need for enhanced antimicrobial stewardship in this area.

PMID:
29771900

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