ABSTRACT
OBJECTIVE: The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. MATERIALS AND METHODS: A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed assessing compliance with guidelines for antibiotic use in SP. Compliance was based on the "Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013" guideline. RESULTS: Sixteen centers were included in the study, with 166 operations performed at these being evaluated. Parenteral antibiotic for SP was applied in 161 (96.9%) of these. Type of antibiotic was inappropriate in 66 (40.9%) cases and duration of use in 47 (29.1%). The main antibiotics used inappropriately in SP were ceftriaxone, glycopeptides and aminoglycosides. No significant difference was observed between secondary and tertiary hospitals in terms of inappropriate selection. Duration of prophylaxis was also incompatible with guideline recommendations in approximately half of surgical procedures performed in both secondary and tertiary hospitals, however statistical significance was observed between institutions in favor of tertiary hospitals. CONCLUSION: Antibiotics are to a considerable extent used in a manner incompatible with guidelines even in tertiary hospitals in Turkey. It must not be forgotten that several pre-, intra- and postoperative factors can be involved in the development of surgical site infections (SSI), and antibiotics are not the only option available for preventing these. A significant improvement can be achieved in prophylaxis with close observation, educational activities, collaboration with the surgical team and increasing compliance with guidelines. All health institutions must establish and apply their own SP consensus accompanied by the guidelines in order to achieve success in SP.
ABSTRACT
The aim of this study was to investigate the clinical prediction criteria for group A beta hemolytic streptococcal (GABHS) pharyngitis in patients with upper respiratory tract infections (URTI). A total of 276 patients admitted to the Ministry of Internal Affairs outpatient clinics with URTI complaints, were included to the study. The clinical findings of the patients were recorded and throat cultures were obtained. The clinical signs and symptoms were as follows; sore throat (56.2%), hypertrophic tonsillitis (53.9%), pharyngeal erythema (50.7%), fever (48.9%), cervical lymphadenopathy (42.8%) and tonsillar exudates (18.5%). The total GABHS isolation rate from throat cultures of the patients were found as 15.9%, and these rates were 19.7% in children, and 7% in adults. Multivariate analysis of the results revealed that the patients with hypertrophic tonsils had GABHS isolation rate seven times more than the patients without hypertrophic tonsils (Odds ratio: 7, confidence interval: 1.4-98, p = 0.017). In conclusion, correct assessment of physical examination findings in the clinical diagnosis of GABHS pharyngitis, will result in less laboratory testing and antibiotic use for sore throat patients.
