Use of prophylactic antibiotics in surgery at a Medical Center in Southern Taiwan

Background and Purpose: Use of prophylactic antibiotics to prevent postoperative infection (POI) is a common practice in surgery. This study investigated the amount and cost of surgical prophylaxis in a representative general hospital in Taiwan in order to determine an appropriate course of action to control antibiotic use and decrease the burden of resistance. Methods: The use of antibiotic prophylaxis for a wide variety of surgical procedures over a 6-month period was retrospectively evaluated in 3,104 patients at a medical center in southern Taiwan. Results: Timing of perioperative parenteral antibiotics was inappropriate in 738 (23.8%) patients. The average duration of antibiotic use was 6.4 days (2.4 days intravenous + 4.0 days oral). Only 4.9% of patients did not receive prophylactic antibiotics and only 9.2% received a single dose. Prophylaxis exceeded 1 day in 80% of patients and 3 days in 68.2%. The most common regimen was cefazolin plus gentamicin, used in 2,338 (75.3%) procedures. There were 146 POIs in 119 (3.8%) patients. The most common POI was at the surgical site. Aerobic Gram-negative bacilli were most common among the 81 pathogens isolated (54.3%), followed by Gram-positive cocci (34.6%), anaerobes (8.6%) and yeasts (2.4%). The total cost for prophylactic antibiotics was New Taiwan (NT) $5,860,242 (∼ US$ 169,862). Had a single dose of cefaxolin been used for all patients. the cost would have been reduced by 92.1%. Had four doses of cefazolin been used, the cost would have been reduced by 68.5%, Conclusions: This study documented the excessive use and often inappropriate timing of administration of antibiotics for surgical prophylaxis in a representative medical center in Taiwan. Strategies are needed to improve the appropriate use of surgical antibiotic prophylaxis in Taiwan, not only to reduce costs but, more importanly, to delay the emergence of resistant microorganisms.