Appropriateness of antibiotic prophylaxis for major surgery in Korea

OBJECTIVE. To determine the appropriateness of antibiotic prophylaxis regimens for major surgery in Korea. DESIGN. Retrospective study using a written survey for each patient who underwent arthroplasty, colon surgery, or hysterectomy. SETTING. Six tertiary hospitals in Seoul and Gyeonggi Province. PATIENTS. From each hospital, a maximum of 150 patients who underwent each type of surgery were randomly chosen for the study. RESULTS. Of 2,644 eligible patients, 1,914 patients were included in the analysis; 677 of these patients underwent arthroplasty, 578 underwent colon surgery, and 659 underwent hysterectomy. Nineteen patients were excluded from the analyses of the class and number of antibiotics used for prophylaxis because they underwent multiple surgeries at different sites. For each of the 1,895 remaining patients, antibiotic prophylaxis involved a mean (+/- SD) of 2.8 +/- 0.9 classes of antibiotics. The most commonly prescribed agents were cephalosporins (prescribed for 1,875 [98.9%] of the patients) and aminoglycosides (1,404 [74.1%]). A total of 1,574 (83.1%) of patients received at least 2 classes of antibiotics simultaneously. Only 15 (0.8%) of 1,895 patients received antibiotic prophylaxis in accordance with published guidelines. Of 506 patients for whom the initial dose of antibiotics was evaluated, 374 (73.9%) received an appropriate initial dose. Of the 1,676 patients whose medical records included information about antibiotic administration relative to the time of surgery, only 188 (11.2%) received antibiotic prophylaxis an hour or less before the surgical incision was made. Of the 1,748 patients whose medical records included information about duration of surgery, antibiotic prophylaxis was discontinued 24 hours or less after surgery for only 3 (0.2%) of the patients. CONCLUSION. Most patients who had major surgery in Korea received inappropriate antibiotic prophylaxis. Measures to improve the appropriateness of antibiotic prophylaxis are urgently required.