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13 Feb 2020

National survey of Australian hospitals highlights a need to improve antibiotic use in surgery

Previous surveys on antimicrobial use in Australian hospitals have shown that prescribing antibiotics to reduce the risk of infections following surgery (surgical prophylaxis) is the most common reason for antimicrobial use in Australian hospitals.

Recently, more in-depth studies have demonstrated that more than half of the antibiotics given for surgical prophylaxis are prescribed inappropriately. Although this rate is improving for surgical procedure groups, with inappropriateness ranging from between 30.3% and 57.1% in 2017 to between 22.6% and 52.3% in 2018. These findings come in a new report, ‘Surgical prophylaxis prescribing in Australian hospitals: Results of the 2017 and 2018 Surgical National Antimicrobial Prescribing Surveys’.

This report also outlines that many of these antibiotics are being prescribed for surgical procedures that do not require any antibiotics following the surgery, which may be contributing to the rise of antibiotic resistance. Resistance to antibiotics is recognised globally as a critical threat to public health, with overuse and inappropriate use of antibiotics being a key contributing factor.

The Surgical National Antimicrobial Prescribing Survey (Surgical NAPS) is an audit tool that is used by Australian hospitals nationally. It was developed by the National Centre for Antimicrobial Stewardship (NCAS) and is delivered by the Guidance Group (Melbourne Health). This audit tool allows for the assessment of the appropriateness of antibiotics prescribed for surgical prophylaxis across all Australian hospitals.

Professor Karin Thursky, NCAS Director, said this type of review “enables participating hospitals to reflect on opportunities to improve the safety and quality of antimicrobial use. We strongly recommend that all Australian hospitals participate in the Surgical NAPS annually as part of their quality improvement activities”.

The Surgical NAPS provides an opportunity for healthcare organisations and surgeons to work together to ensure that surgical prophylaxis is prescribed in accordance with evidence-based antibiotic prescribing guidelines.

Dr. Rodney James, who is the Director of Clinical Services for the Guidance Group at Melbourne Health, says, “The Surgical NAPS examines various aspects of surgical prophylaxis prescribing. Sometimes, it is the duration of treatment that is inappropriate (too long); sometimes it is the dose or the timing of administration that is not in concordance with the recommended prescribing guidelines. Therefore, there are several factors involved that need to be addressed.”

“The aim of the Surgical NAPS is to provide detailed information regarding surgical prophylaxis to help surgeons, pharmacists and nurses understand which aspects of prescribing, such as antimicrobial choice, timing, dose or duration, can be improved. We also acknowledge that antibiotic overuse is not just a surgical problem, but a societal problem that requires a 'one health' approach. Therefore, the Guidance Group, in collaboration with the National Centre for Antimicrobial Stewardship, is constantly developing new auditing tools to help understand the reasons for inappropriate prescribing in all healthcare settings.”

The results of the Surgical NAPS have been communicated to all participating hospitals to facilitate local quality-improvement initiatives and published as part of the Antimicrobial Use and Resistance in Australia (AURA) Surveillance System.

Key Findings

7,183 and 5,637 surgical episodes were included in the analysis of the 2017 and 2018 Surgical NAPS respectively. Key findings include:

  • Procedural antimicrobials – administered either immediately prior to or during the surgical procedure – were prescribed in 5,082 surgical episodes (70.8%, 6,022 doses) in 2017 and 4,030 episodes (71.5%, 4,700 doses) in 2018.
    • Of these episodes, 44.5% in 2017 and 37.8% in 2018 had at least one inappropriate prescribing element, mostly incorrect timing.
  • Post-procedural antimicrobials – administered following, but directly relating to, the procedure – were prescribed in 2,075 surgical episodes (32.3%) in 2017 and 1,728 episodes (33.8%) in 2018.

    • Of these episodes, 58.7% in 2017 and 62.1% in 2018 had at least one inappropriate prescribing element, mostly the fact that post-procedural prophylaxis was not required.