Quality of perioperative chemoprophylaxis in general surgery: Preliminary results of ASPPOC in South Europe

Abstract

Aim: The ASPOC Project (ASPPOC, Antibiotic Surveillance Project on Perioperative Chemoprophylaxis) is a multicentric study carried out in European countries, aiming at improving the quality and establishing a successful and evidence-based perioperative chemoprophylaxis. The aim of this study, which is part of ASPPOC, was to check conformance to the guidelines for perioperative chemoprophylaxis in General Surgery, and to trace out changes that must be made in South European countries to improve its quality. Methods: 6 European countries participated in the study: Greece, Italy, Serbia, Croatia, Slovenia and Montenegro. Conformance to the recommended guidelines and quality of perioperative chemoprophylaxis were checked by use of the same questionnaire in each country. The following criteria of quality in chemoprophylaxis were checked: 1) application of chemoprophylaxis, 2) duration and time of initiation of chemoprophylaxis and 3) the kind of antibiotics used. Results: A different practice on application and quality of perioperative chemoprophylaxis was observed in each country, and sometimes in different Surgery Departments of the same country. Chemoprophylaxis was usually initiated during preinduction to anesthesia but its duration exceeded the maximum recommended time of 24 hours in many cases in all countries except Italy. The recommended beta-lactams (ATC code J01C and J01D) were used in most cases; metronidazole (ATC code J01XD01) or clindamycin (ATC code J01FF01) was used in cases of anaerobic contamination; vancomycin (ATC code J01XA01) was used in cases of high percentage of MRSA in hospital flora. 3rd generation cephalosporins (ATC code J01DD) were used in Serbia, Slovenia and Montenegro. Gentamicin (ATC code J01GB03) was used in some operations in Croatia and Slovenia, and amikacin (ATC code J01GB06) was used in Serbia. Ciprofloxacin (ATC code J01MA02) was also used in Slovenia. Conclusions: The quality of perioperative chemoprophylaxis was not satisfactory, and serious inconsistencies to the recommended guidelines were observed in many cases. Dynamic changes are required in order to improve the quality and establish a successful and evidence-based perioperative chemoprophylaxis in general surgery. ©PHARMAKON-Press.