Evaluation ofthe ProphylacticAntibioticPoliciesofCardiacSurgeryinaUniversityTeaching Hospital

Abstract

Background: Antimicrobial prophylaxis in cardiac surgery has been demonstrated to lower the incidence of postoperative infection. Inappropriate antimicrobial prophylaxis, as inappropriate selection of the antimicrobial agent ordosing regimen, can increase the prevalence of antibiotic resistant strains, prolong hospital stay, cause postoperative infection, and negatively affect an institution’s pharmacy budget for antibiotics. Objective:To assess the current postoperative prophylactic antibiotic protocols applied in the cardiac surgeries department in Ain Shams University teaching hospitals with respect to others and to international guidelines for antimicrobial prophylaxis practice in cardiac surgery. Methods: 320 pediatric and adult patients who were admitted for cardiac surgery to Ain Shams University teaching hospitals from September 2012 until March 2013.The antimicrobial prophylaxis indication, choice, duration, dose, dosing interval, and timing appropriateness were assessed against 3 international guidelines using a pre-tested, structured clinical data collection form. The study design was prospective observational. All study patients were monitored daily during their inpatient stay until discharge. Data regarding surgery duration, mechanical ventilation duration, intensive care unit stay, postoperative stay and total hospital stay were obtained. Results:Adherence to all antimicrobial prophylaxis guidelines was not achieved for any study patients. A statistical significant difference for the mechanical ventilation duration, Intensive care unit stay, postoperative stay and total hospital stay were found concerning both the pediatrics and the adults between the infected and non-infected group. Conclusion:Study findings indicate that adherence to international guidelines for antimicrobial prophylaxis is far from optimal in cardiothoracic department at Ain Shams University teaching hospitals, due to the inappropriate administration of many antibiotics. Developing local hospital guidelines, as well as giving the clinical pharmacist a central role in the administration, monitoring, and intervention of antimicrobial prophylaxis may improve the current practice. Key Words: Prophylactic Antibiotic, Antibiotic Resistance, Nosocomial Infection, Clinical Pharmacy.