Surgeons still don't administer antimicrobial prophylaxis correctly

Despite knowing for years that giving antibiotics prior to surgery reduces the risk of infection, antimicrobial prophylaxis is administered properly only about half the time. According to a national retrospective cohort study involving 34,133 Medicare inpatients undergoing a variety of surgeries, only 0.7% of patients did not receive any prophylactic antimicrobial agent, but an antibiotic was administered within the recommended 1 hour prior to incision to only 55.7% of patients. Those undergoing cardiac or orthopedic surgery were more likely than others to receive an antibiotic within the recommended time frame. Almost 10% of patients received their first antimicrobial dose more than 4 hours after incision. On a more positive note, 92.6% of patients received the correct drug, that is, an antimicrobial agent consistent with published recommendations.

On the other hand, physicians seem reluctant to discontinue prophylactic antibiotics on schedule. The drugs were discontinued within the recommended 24 hours after surgery was completed in only 40.7% of patients. Those undergoing cardiac surgery or knee or hip arthroplasty were most likely to continue receiving antibiotics past the recommended cut-off, although the median duration of antibiotic prophylaxis was longest (57.0 hours) for patients undergoing colon surgery. Overall, 2 days after the end of surgery, 26.7% of patients were still receiving antibiotics, and 9.3% continued to receive antimicrobials for more than 96 hours after surgery.

Bratzler DW, Houck PM, Richards C, et al. Use of antimicrobial prophylaxis for major surgery: Baseline results from the National Surgical Infection Prevention Project. Arch Surg. 2005;140:174-182.