Guideline Concordance Evaluation of Antimicrobial Usage in Surgical Patients at University Hospital, Thailand
Pitchaya Dilokpattanamongkol BCCCP*, Supatat Chumnumwat PharmD*, Supawat Takultacha PharmD candidate*, Sirawit Songsomboon PharmD candidate*, Preecha Montakarntikul PharmD*, Nantaporn Lekpittaya RPh, MS**, Paphon Sa-ngasoongsong MD***, Preeda Sumritpradit MD****
Affiliation : * Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand ** Clinical Pharmacy Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand *** Department of Orthopedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand **** Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Overview: Several studies have shown antimicrobial usage was non-concordant with clinical practice guidelines for
antimicrobial prophylaxis in surgery. However, there have not been any studies related to antimicrobial usage in surgical
patients at Ramathibodi Hospital.
Objective : The purpose of this study was to characterize the concordance of antimicrobial surgical prophylaxis with the
guidelines and to evaluate appropriateness of antimicrobial use during hospitalization.
Material and Method: We prospectively collected data from 187 surgical patients receiving antimicrobial at three surgical
wards, Ramathibodi Hospital between September and December 2016.
Results : There were 159 (85.0%), 129 (69.0%), 36 (19.3%), 147 (78.6%), 136 (72.7%) and 69 (36.9%) patients consistent
with indication, drug of choice, dose, timing, re-dosing, and duration, respectively, was concordant with the American Society
of Health-System Pharmacists (ASHP) 2013 guideline. Only orthopedic surgery was a significant factor for non-concordance
in term of duration (odd ratio [OR] = 3.966, p<0.001, 95% confidence interval [CI] 1.828 to 8.606). Moreover, only 5.9%
of patients had appropriate indications for prescribing antimicrobial as home medications.
Conclusion : Antimicrobial use for surgical prophylaxis was highly correlated with ASHP 2013 guideline, except for the dose
and the duration aspects. However, overall antimicrobial prescriptions in surgical and orthopedic wards were not entirely
concordant with the guidelines. Interventions to improve guideline concordance of antimicrobial surgical prophylaxis and to
decrease unnecessary antimicrobial prescriptions are required.
Keywords : Antimicrobial prophylaxis, Surgery, Surgical prophylaxis, Antibiotic
