Antimicrobial-impregnated bone cement use in Australian hospitals: scoping pharmacist awareness and involvement in management

BackgroundAntibiotic-impregnated bone cement (AIBC) is frequently used in arthroplasty surgery to minimise the risk of infection in the prosthetic knee or hip joint.AimTo gain greater insight into the use, documentation, and stock-management of AIBC in Australian hospitals.MethodA mixed-methods study was conducted. Antimicrobial surveillance data were analysed to identify Australian hospitals including AIBC in their monthly pharmacy data submissions. An online survey was distributed to pharmacists registered with the National Antimicrobial Utilisation Surveillance Program to investigate knowledge of the use, documentation, and stock-management of bone cement.ResultsSurveillance data from January to June 2021 showed 13% (n = 28) of the 222 participating hospitals included bone cement in their antimicrobial usage data. All reported AIBC usage data contained an aminoglycoside antibiotic. Fifty-two pharmacists responded (17% response rate) to the online survey. When asked about inventory, 35% of participants stated that their hospital pharmacies manage bone cements. Of 82 responses, 6% (n = 5) had knowledge of additional antibiotics or antifungals loaded into bone cements intraoperatively. More than half of the respondents reported that documentation of AIBC use was unclear, while others knew to search for it in prosthesis or theatre notes.ConclusionThis study has illustrated a gap in pharmacists' knowledge in the perioperative setting regarding the use and documentation of bone cement, and highlights a possible focus for future education to assist with antimicrobial stewardship in this setting. Consistency in the management and documentation of AIBC would assist in surveillance of usage, help identify variations in practice and provide opportunities for quality improvement.