Antibiotic Use Among Older Adults on an Acute Care General Surgery Service

Overview

Journal Can J Surg

Specialty General Surgery

Date 2017 Sep 21

PMID 28930045

Citations 1

Authors

Andre S Pollmann

Jon G Bailey

Philip J B Davis

Paul M Johnson

Affiliations

Soon will be listed here.

Abstract

Background: Antibiotics play an important role in the treatment of many surgical diseases that affect older adults, and the potential for inappropriate use of these drugs is high. Our objective was to describe antibiotic use among older adults admitted to an acute care surgery service at a tertiary care teaching hospital.

Methods: Detailed data regarding diagnosis, comorbidities, surgery and antibiotic use were retrospectively collected for patients 70 years and older admitted to an acute care surgery service. We evaluated antibiotic use (perioperative prophylaxis and treatment) for appropriateness based on published guidelines.

Results: During the study period 453 patients were admitted to the acute care surgery service, and 229 underwent surgery. The most common diagnoses were small bowel obstruction (27.2%) and acute cholecystitis (11.0%). In total 251 nonelective abdominal operations were performed, and perioperative antibiotic prophylaxis was appropriate in 49.5% of cases. The most common prophylaxis errors were incorrect timing (15.5%) and incorrect dose (12.4%). Overall 206 patients received treatment with antibiotics for their underlying disease process, and 44.2% received appropriate first-line drug therapy. The most common therapeutic errors were administration of second- or third-line antibiotics without indication (37.9%) and use of antibiotics when not indicated (12.1%). There was considerable variation in the duration of treatment for patients with the same diagnoses.

Conclusion: Inappropriate antibiotic use was common among older patients admitted to an acute care surgery service. Quality improvement initiatives are needed to ensure patients receive optimal care in this complex hospital environment.

Citing Articles

A Danish study on emergency or urgent surgery for small bowel obstruction in adults: Incidence, causes, administration of antibiotics, and infectious complications.

Boolsen A, Brandstrup B Surg Open Sci. 2022; 7:30-35.

PMID: 35005586 PMC: 8719015. DOI: 10.1016/j.sopen.2021.11.004.

References

Sturkenboom M, Goettsch W, Picelli G, In t Veld B, Yin D, de Jong R . Inappropriate initial treatment of secondary intra-abdominal infections leads to increased risk of clinical failure and costs. Br J Clin Pharmacol. 2005; 60(4):438-43. PMC: 1884818. DOI: 10.1111/j.1365-2125.2005.02443.x. View

Gleckman R . Antibiotic concerns in the elderly. A clinician's perspective. Infect Dis Clin North Am. 1995; 9(3):575-90. View

Holmberg S, Solomon S, Blake P . Health and economic impacts of antimicrobial resistance. Rev Infect Dis. 1987; 9(6):1065-78. DOI: 10.1093/clinids/9.6.1065. View

Forbes S, Stephen W, Harper W, Loeb M, Smith R, Christoffersen E . Implementation of evidence-based practices for surgical site infection prophylaxis: results of a pre- and postintervention study. J Am Coll Surg. 2008; 207(3):336-41. DOI: 10.1016/j.jamcollsurg.2008.03.014. View

Krobot K, Yin D, Zhang Q, Sen S, Altendorf-Hofmann A, Scheele J . Effect of inappropriate initial empiric antibiotic therapy on outcome of patients with community-acquired intra-abdominal infections requiring surgery. Eur J Clin Microbiol Infect Dis. 2004; 23(9):682-7. DOI: 10.1007/s10096-004-1199-0. View

Solomkin J, Mazuski J, Bradley J, Rodvold K, Goldstein E, Baron E . Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2009; 50(2):133-64. DOI: 10.1086/649554. View

McHugh S, Corrigan M, Dimitrov B, Cowman S, Tierney S, Hill A . Preventing infection in general surgery: improvements through education of surgeons by surgeons. J Hosp Infect. 2011; 78(4):312-6. DOI: 10.1016/j.jhin.2011.03.023. View

Davies S, Efird J, Guidry C, Hranjec T, Metzger R, Swenson B . Characteristics of surgical patients receiving inappropriate empiric antimicrobial therapy. J Trauma Acute Care Surg. 2014; 77(4):546-54. PMC: 4699284. DOI: 10.1097/TA.0000000000000309. View

Drew R . Antimicrobial stewardship programs: how to start and steer a successful program. J Manag Care Pharm. 2009; 15(2 Suppl):S18-23. PMC: 10437655. DOI: 10.18553/jmcp.2009.15.s2.18. View

10.

Popovski Z, Mercuri M, Main C, Sne N, Walsh K, Sung M . Multifaceted intervention to optimize antibiotic use for intra-abdominal infections. J Antimicrob Chemother. 2014; 70(4):1226-9. DOI: 10.1093/jac/dku498. View

11.

Cakmakci M . Antibiotic stewardship programmes and the surgeon's role. J Hosp Infect. 2015; 89(4):264-6. DOI: 10.1016/j.jhin.2015.01.006. View

12.

Silber J, Rosenbaum P, Trudeau M, Chen W, Zhang X, Lorch S . Preoperative antibiotics and mortality in the elderly. Ann Surg. 2005; 242(1):107-14. PMC: 1357711. DOI: 10.1097/01.sla.0000167850.49819.ea. View

13.

Putnam L, Chang C, Rogers N, Podolnick J, Sakhuja S, Matusczcak M . Adherence to surgical antibiotic prophylaxis remains a challenge despite multifaceted interventions. Surgery. 2015; 158(2):413-9. DOI: 10.1016/j.surg.2015.04.013. View

14.

Srigley J, Brooks A, Sung M, Yamamura D, Haider S, Mertz D . Inappropriate use of antibiotics and Clostridium difficile infection. Am J Infect Control. 2013; 41(11):1116-8. DOI: 10.1016/j.ajic.2013.04.017. View

15.

Guilbart M, Zogheib E, Ntouba A, Rebibo L, Regimbeau J, Mahjoub Y . Compliance with an empirical antimicrobial protocol improves the outcome of complicated intra-abdominal infections: a prospective observational study. Br J Anaesth. 2016; 117(1):66-72. PMC: 4913397. DOI: 10.1093/bja/aew117. View

16.

Bare M, Castells X, Garcia A, Riu M, Comas M, Egea M . Importance of appropriateness of empiric antibiotic therapy on clinical outcomes in intra-abdominal infections. Int J Technol Assess Health Care. 2006; 22(2):242-8. DOI: 10.1017/S0266462306051063. View

17.

Di Saverio S, Tugnoli G, Catena F, Birindelli A, Coniglio C, Gordini G . Surgeon accountability for patient safety in the Acute Care Surgery paradigm: a critical appraisal and need of having a focused knowledge of the patient and a specific subspecialty experience. Patient Saf Surg. 2015; 9:38. PMC: 4644281. DOI: 10.1186/s13037-015-0084-3. View

18.

Classen D, Evans R, Pestotnik S, Horn S, Menlove R, Burke J . The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med. 1992; 326(5):281-6. DOI: 10.1056/NEJM199201303260501. View

19.

Davey P, Brown E, Charani E, Fenelon L, Gould I, Holmes A . Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2013; (4):CD003543. DOI: 10.1002/14651858.CD003543.pub3. View

20.

Lim M, Lai P, Ponnampalavanar S, Faridah Syed Omar S, Taib N, Yusof M . Antibiotics in surgical wards: use or misuse? A newly industrialized country's perspective. J Infect Dev Ctries. 2015; 9(11):1264-71. DOI: 10.3855/jidc.6731. View