Abstract
Background: The use of surgical antimicrobial prophylaxis (SAP) against surgical site infections (SSI) is a global practice which has greatly improved morbidity and mortality. However, with the rise in microbial resistance, antimicrobial stewardships (AMS) have developed guidelines for safe appropriate practices. The Canterbury District Hospital Board (CDHB) Pink Book, (2018) has SAP guidelines for Upper GI and Biliary Tract which covers laparoscopic cholecystectomy (LC). Over the years it has been noticed SAP does not decrease the rate of SSI in patients having LC. This is due to LC being of such low risk that there is acknowledgment under international guidelines not using SAP for low-risk LC is an appropriate treatment regimen (Australian Therapeutic Guidelines, 2019). CDHB Pink Book guidelines do not include a no SAP regimen. By reducing antimicrobials, microbial resistance is reduced, adverse drug reactions (ADR) avoided and secondary infections such as Clostridium diffiicle do not develop.
Aims: To describe the pattern of surgical SAP for patients undergoing elective LC in Christchurch in the last half of 2020 and to determine compliance of SAP regimens used for patients undergoing laparoscopic cholecystectomy with CDHB Pink Book Guidelines.
Methodology and methods: A retrospective audit was used for the study design and a quantitative methodology was applied throughout the project. Records were identified from CDHB surgical hospitals and then selected for inclusion and exclusion criteria. A PRISMA model assisted with final selection of patients. Data was deidentified and collected onto spreadsheets which were adapted from the Australian National Antimicrobial Prescribing Survey (NAPS) and saved on password protected computers. Descriptive statistics were used in data analysis of patient, surgical and SAP characteristics and practices.
Results: Patient characteristics were tabled and displayed to show risk factor for SSI development in surgery as well as antimicrobial allergies. Surgical data was analysed in conjunction with SAP administration to enable SAP regimens to be identified and assessed for compliance under the CDHB Pink Book guidelines and then assessed for appropriateness using the Australian Therapeutic Guidelines.
Conclusion: It was found that 55% of the study population received SAP regimens for low-risk LC which complied with the CDHB Pink Book while 45% did not comply. This noncompliance was mainly due to 41(32%) patients who did not receive SAP. This was a surprising result but a good AMS development. The noncompliance of the no SAP regimen was then assessed for appropriateness with the Australian Therapeutic Guidelines, under which this regimen is defined as appropriate. This result will contribute to guideline discussion and development.