Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw

1. Perioperative antibiotic prophylaxissubprojectBARN 4th Workshop, 9-10 October 2013, Warsaw Hospital of Lithuanian University of Health Sciences Kauno Klinikos Institute of Hygiene dr.G.Gailiene

2. Aim: To evaluate the quality of perioperative antibiotic prophylaxis (the adherence to the local prophylaxis guidelines) in the countries of Baltic Sea region. • Objectives: • Evaluation of existing local AB stewardship; • Estimation of patients, who received AB within 1 hr – 15 min prior to incision; • Estimation of patients, who received AB based on the local guidelines; • Estimation of patients, who received AB after 24 hr; • Antibiotics used for prophylaxis;

3. Methods • Multicenter prospective observational study; • Duration 2 weeks (10 working days); • Pilot studywas performed in November-December 2012 in General Surgery Department and Orthopedic Department of Hospital of Lithuanian University of Health Sciences Kauno Klinikos. • Main study – March - June 2013 – in departments of: • Obstetric - Gynaecology, • Cardiosurgery; • General Surgery.

4. Participants of subproject: • Greta Gailiene, Zilvinas Dambrauskas, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Lithuania; • Uga Dumpis, Aija Vilde, Pauls Stradini University Hospital, Latvia; • Piret Mitt, Tartu University Hospital, Estonia; • Pille Martin, West - Tallinn Central Hospital,Estonia; • Birgitta Lytsy, Uppsala University Hospital, Sweden.

5. General data

6. Results

7. AB stewardship SE 2(LV,SE) 3(LT,EE,EE2) • AB doses • AB prescription duration • route of AB administration • alternative AB 3(EE,EE2,SE), 2(LV,LT) 3(EE,EE2,SE) 2 (LV,LT) 3(EE,SE,EE2) 2(LV,LT) 2(EE,EE2) 3(LV,LT,SE) 3(EE,EE2,SE) 2(LV,LT) 2(EE,EE2); 3(LV,LT,SE)

8. Obstetric – gynaecology Types of surgery (N)

9. Obstetric – gynaecology surgeryAB prophylaxis (%) *LV - 38.9 % patients received AB more than 1 hr prior to incision; ** EE - 1 (4.3%) patient received AB 8 min after incision; 30.4% patients did not received AB before operations (PAP is indicated only for hysterectomy, but 4 (out of 10) patients with ovarian surgery received PAP); *** EE (2) 45.4 % patients received AB more than 1 hr prior to incision, 4.5% patients did not received AB.

10. AB used for prophylaxis before Obstetric- gynaecology surgery (%)

11. CardiosurgeryTypes of surgery (N)

12. CardiosurgeryAB prophylaxis (%) *LV - 52.2 % patients received AB more than 1 hr prior to incision

13. AB used for prophylaxis before Cardiosurgery (%)

14. Abdominal surgeryTypes of surgery (N)

15. Abdominal surgeryAB prophylaxis (%) *EE - 1 (2.2%) patient received AB after incision; ** EE (2) - 12.5% patients received first dose of AB on time of incision or after incision; 41.6 % patients did not received AB before operations; *** LV - 9.7 % patients received AB after incision.

16. AB used for prophylaxis before Abdominal surgery (%)

17. AB appointment before surgery (%)

18. Resume: • Multidisciplinary AB-team has only one hospital (20.0%). • PAP protocol updated according to the local antimicrobial susceptibility patterns in 3 hospitals (60.0%). • One or more audits for compliance with the PAP protocol are performed in 2 hospitals (40.0%). • Antibiotic timing (1 h or 15-30min.) and appointment (surgeon or anesthesiologist, or both) before operation depends on the type of surgery, i.e. depends on ward, but not on hospital (except Tartu university hospital). • Patients received AB more than 1 hr prior incision in 2 hospitals, in 3 hospitals - AB after incision. • 4.35 – 98.5 % of patient received AB after 24 hr in all (5) hospitals, based on the Guidelines – in 2 hospitals. • 1st and 2nd gen cephalosporins or combinations with other antibiotics were used most common for prophylaxis.

19. Recommendations • Repeat study; • Expand: • number of participating: • persons • departments • countries • duration of study • protocol (AB name, dose, precise injection or oral administration time)

20. Thank you for attention