Antimicrobial prophylaxis in surgery in Belgian hospitals: Room for improvement

Objective: To evaluate the current practice of surgical antimicrobial prophylaxis in Belgium. Design: Prospective multicentre incidence study. Setting: 58 of the 206 acute hospitals in Belgium. Subjects: 19746 patients who had operations between October 1992 and June 1993, with detailed analysis of 7983 procedures for which the antimicrobial regimens were known. Results: Antibiotic prophylaxis was given before 14099 (71%) of the 19746 operations. It was given in 57% of the procedures for which prophylaxis is generally not recommended, but it was not used in 14% of procedures for which it is generally recommended, nor in 14% of all contaminated procedures. Duration of operation superseded degree of wound contamination, ASA (American Society of Anesthesiologists) score, and degree of urgency as a predictor of the use of prophylaxis. Prophylaxis was prolonged by more than 2 days postoperatively after 23% of the procedures and by more than 4 days in 8%. Five types of regimens accounted for 80% of all prophylaxis, but overall 234 different regimens were prescribed. Large differences were found in hospital university affiliation status. In general, trends were favourable compared with a study in 1986. Conclusion: Although there was improvement compared with 1986, antimicrobial prophylaxis in surgery could still be more appropriate in terms of indication, duration, and rational choice of drugs.