Major reasons to prescribe antimicrobial prophylaxis in surgery.

Based on the Belgian recommendation for antimicrobial prophylaxis (AMP) in surgery in 1996, a prospective survey of 3 months was carried out in 10 acute care hospitals in Lebanon to describe the major reasons to prescribe AMP in surgery. Of 961 surgical procedures, 767 (80%) received one or several antibiotics; the surgical site infection rate was 4%. Results indicate that duration of procedures over 1 hour and patient older than 60 years represent the main reasons for prescribing AMP in Lebanese hospitals.

Survey of antimicrobial prophylaxis for surgical procedures in Lebanese hospitals.

Antimicrobial prophylaxis (AMP) is an effective measure to prevent the surgical site infection (SSI). This prospective survey of three months describe the adequacy of AMP in 10 acute care hospitals (affiliated to the Lebanese University, Faculty of Medical Sciences) based on international guidelines for only three parameters, digestive, orthopaedic and vascular surgery. Out of 964 surgical procedures, 916 (95%) were eligible for AMP, of which 767 (84%) received one or several antibiotics. Cefazolin was frequently prescribed (49%), followed by beta-lactamase-inhibitor/penicillin (18%), cefuroxime (17%), ceftriaxone (7%) and vancomycin (0.1%). In compliance with current US guidelines on indication, choice of drug, duration and time of first dose administration, AMP was given for only 32% of the procedures. Duration of AMP was < or = 24 hours in 35% and exceeded 48 hours in 57%. A single dose of prophylaxis was given to 26%, 12% receive an additional dose and 62% receive more than 2 doses. The first dose was administered within 30 min before operation in 92% of procedures. We conclude that AMP in Lebanese hospitals was fairly adequate in terms of respecting indications for selected surgical procedures. Improvement could be made by reducing the duration of prophylaxis and avoiding the use of broad-spectrum antibiotics.