Vol.52 No.9 September 2004
Current status of prophylactic antibiotic therapy for prevention of postoperative infections after gastrointestinal surgery A questionnaire covering 3,823 surgeons
1)3rd Department of Surgery, Toho University School of Medicine, 2-17-6 Ohashi, Meguro-ku, Tokyo, Japan
2)Department of Surgery Division of Clinical Medical Science Programs for Applied Biomedicine Graduate School of Biomedical Sciences Hiroshima University
Abstract
Objectives: Guidelines issued by the CDC or the "Guidelines for Antibiotic Usage" (issued by the Japanese Association for Infectious Diseases and the Japanese Society of Chemotherapy) give currently recommended prophylaxis with antibiotics. We surveyed the status of their implementation.
Methods: In August and September 2003, a questionnaire was distributed to 3,823 surgeons in 47 Japanese administrative districts (567 surgeons in Hokkaido/Tohoku, 1,051 in Kanto, 324 in Tokai, 262 in Hokuriku/Shinetsu, 643 in Kinki, 495 in Chugoku/Shikoku, and 481 in Kyushu/Okinawa). The implementation of recommendations in guidelines was compared for geographic area, type of hospital, number of beds, and clinical experience of surgeons.
Results: Implementation of recommendations was 35% in the selection of prophylactic antibiotics (large bowel, second-generation cephamycins) and 63% for the timing of administration (just prior to surgery). For the administration period (< =4 days), implementation was 63% for gastric surgery (56% for 3 to 4 days and 7% for short-term therapy) and 51% for large bowel surgery. Implementation was low for the selection of prophylactic antibiotics. The highest implementation of long-term administration was 49% in the Tokai area. Concerning the type of hospital, a difference in long-term administration was seen between general hospitals (44%) and educational hospitals (31%). Concerning the number of beds, hospitals with fewer than 100 beds showed a lower rate of adherence to recommendations than hospitals having 500 or more beds, including lower administration just prior to surgery (45% vs. 66%) and higher long-term administration (62% vs. 34%). Concerning clinical experience, more surgeons with less than 5 years of experience followed recommendations than surgeons who had 20 years or more of experience, especially for selection of antibiotics (41% vs. 34%), timing of administration (73% vs. 55%), and administration period (68% vs. 59%).
Conclusions: Implementation of recommendations was low and further education is thought to be necessary in general hospitals or hospitals with fewer than 100 beds and among surgeons with 20 years of experience or more. Concerning the administration period and the selection of antibiotics for large bowel surgery, marked differences were seen from CDC recommendations, so it may be desirable for randomized clinical trials to be conducted in Japan.
Key word
prophylactic antimicrobial agent, colorectal surgery, cephamycin, postoperative infection, questionnaire, survey
Received
June 7, 2004
Accepted
July 15, 2004
Jpn. J. Chemother. 52 (9): 474-485, 2004
