Perioperative antibiotic prophylaxis: improved compliance and impact on infection rates

The aims of this study were to determine adherence to the perioperative antibiotic prophylaxis (PAP) protocol used at a large Italian teaching hospital during a 6-year period, to assess the variables associated with inappropriate administration, and to measure the impact on surgical site infection (SSI) rates. There were 28 621 patients surveyed of which 74.6% received PAP. An improvement in adherence to the PAP protocol was registered for 58.8% of patients. Significant risk factors were an American Society of Anesthesiologists (ASA) score >= 2 [odds ratios (OR) from 1.28 (95% confidence interval (CI) 1.19-1.37) to 1.87(95% CI 1.43-2.44)], prolonged duration of surgery (OR 1.68, 95% CI 1.56-1.82) and urgent surgery (OR 2.16, 95% CI 1.96-2.37). During the study period, a significant reduction in SSIs rates was detected. We concluded that the global reduction of inadequate PAP administration signifies the efficacy of a multidisciplinary quality improvement initiative on antimicrobial utilization, and this is supported by the observed reduction of the SSI rate.