Concordance of perioperative prophylactic antibiotic therapy with national Iranian guidelines in Shiraz University Hospitals, Shiraz- Iran, 2004

Surgical site infection is the most common complication of surgery and can be prevented with the appropriate use of prophylactic antibiotics. In fact, some complications may occur such as emergence of resistant bacteria and increased costs are due to inappropriate use of antibiotics. We have designed this descriptive study to recognize the current status of surgical antibiotic prophylaxis comparing with the National Iranian Guideline (NIG). 760 patients in 7 different surgical wards from 6 university hospitals in Shiraz enrolled to the study. Using the NIG as reference, we considered indices like the decision making toward the prescription of prophylactic antibiotics, antimicrobial agents, starting time, duration, route of administration of prophylactic antibiotics and total adherence to the guideline for each patient. It was found that 82.1% of decision making regarding prescriptions were on the base of the guidelines. Comparing with the guideline, drug selection, initiation time, duration, and route of prophylaxis was appropriate in 2.9%, 55%, 0%, and 30.7% of patients, respectively. However the total adherence was 0%. This study showed significant discrepancies between the NIG recommendations and the current prophylactic practice. An interventional study is essential in order to improve prophylactic antibiotic prescription, patient safety, infection control and to decrease complications.