Usage of Surgical Antibiotic Prophylaxis in Routine Otolaryngologic Surgeries in Turkey

Abstract

Introduction: Inappropriate antibiotic use in the world leads to an increase in both health care costs and antibiotic resistance. Surgical antibiotic prophylaxis (SAP) is used by most surgeons, especially in the postoperative period.

Objective The aim of the study is to determine the approach of ear, nose, and throat (ENT) specialists to surgical antibiotic prophylaxis in routine surgeries, and to raise awareness regarding inappropriate antibiotic use.

Methods ENT specialists from all over Turkey participated in the study by filling out a data collecting form. The form consisted of 6 questions and was sent to specialists via email. Routine ENT operations such as adenoidectomy, tonsillectomy, adenotonsillectomy, ventilation tube application, septoplasty, rhinoplasty, septorhinoplasty (noncomplicated), tympanoplasty, and simple mastoidectomy were chosen for the study. Data were analyzed statistically.

Results The form results of 110 ENT specialists were evaluated. The rate of participants who used and did not use SAP was 77.3% and 22.7%, respectively. The SAP usage rates of septoplasty, rhinoplasty, and septorhinoplasty operations were 84.7%, 81.2%, and 75.3%, respectively. For tympanoplasty and ventilation tube application operations, the rates were 82.4% and 24.7%, respectively. Finallly, the SAP usage rates of adenoidectomy, tonsillectomy, and adenotonsillectomy were 57.6%, 75.3%, and 72.9%, respectively.

Conclusion Otolaryngological surgeries are often classified as clean or clean-contaminated surgeries. In most studies in the literature, it is reported that SAP use is unnecessary in routine otolaryngological surgery. Providing inservice training, regularly updating the prophylaxis guidelines and sharing these guidelines with surgeons may prevent inappropriate SAP use.

Keywords

infection - antibiotic prophylaxis - ear nose and throat

Publikationsverlauf

Eingereicht: 09. Januar 2021

Angenommen: 14. Februar 2022

Artikel online veröffentlicht:
11. Juli 2022

• References

• 1 Australia Department of Health, Australia Department of Agriculture.. (2015) Responding to the threats of antimicrobial resistance: Australia's first national antimicrobial resistance strategy. 2015–2019. Canberra, Australia.:
• 2 AURA.. (2017) Second Australian report on antimicrobial use and resistance in human health. Creative Commons Attribution.. https://www.safetyandquality.gov.au/publications-and-resources/resource-library/aura-2017-second-australian-report-antimicrobial-use-and-resistance-human-health
• 3 Ahmadzada S, Wong EH, Naidoo Y. Antibiotic prescribing practices in otolaryngology head and neck surgery in Australia and New Zealand: A survey of 137 specialists. Aust J Otolaryngol 2019; 2: 11
• 4 Bratzler DW, Dellinger EP, Olsen KM. et al; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70 (03) 195-283
• 5 Nagarajan SS, Sarma RK, Deka RC. The costing of common otologic surgical procedures so as to develop standard approach for introduction of a package system of charging the patients. J Acad Hosp Adm 2000; 12: 61-63
• 6 Australian Institute of Health and Welfare.. (2017) Elective surgery waiting times 2016–17: Australian hospital statistics. Health services series no. 82. Cat. no. HSE 197.. Canberra:: AIHW.;
• 7 Avenia N, Sanguinetti A, Cirocchi R. et al. Antibiotic prophylaxis in thyroid surgery: a preliminary multicentric Italian experience. Ann Surg Innov Res 2009; 3: 10
• 8 Özgün H, Ertugrul BM, Soyder A, Öztürk B, Aydemir M. Peri-operative antibiotic prophylaxis: adherence to guidelines and effects of educational intervention. Int J Surg 2010; 8 (02) 159-163
• 9 Lallemand S, Thouverez M, Bailly P, Bertrand X, Talon D. Non-observance of guidelines for surgical antimicrobial prophylaxis and surgical-site infections. Pharm World Sci 2002; 24 (03) 95-99
• 10 Dhiwakar M, Clement WA, Supriya M, McKerrow W. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst Rev 2010; 7 (07) CD005607
• 11 Aljfout Q, Alississ A, Rashdan H, Maita A, Saraireh M. Antibiotics for Post-Tonsillectomy Morbidity: Comparative Analysis of a Single Institutional Experience. J Clin Med Res 2016; 8 (05) 385-388
• 12 Grandis JR, Johnson JT, Vickers RM. et al. The efficacy of perioperative antibiotic therapy on recovery following tonsillectomy in adults: randomized double-blind placebo-controlled trial. Otolaryngol Head Neck Surg 1992; 106 (02) 137-142
• 13 Padia R, Olsen G, Henrichsen J. et al. Hospital and surgeon adherence to pediatric tonsillectomy guidelines regarding perioperative dexamethasone and antibiotic administration. Otolaryngol Head Neck Surg 2015; 153 (02) 275-280
• 14 Royal Australisian College of Surgeons. (2014) Procedure list for Otolaryngology Head and Neck Surgery. Morbidity Audit and Logbook Tool.. Available online: https://www.surgeons.org/media/20676730/2014–02–11_doc_ohns_procedure_list.pdf
• 15 Valdez TA, Marvin K, Bennett NJ, Lerer T, Nolder AR, Buchinsky FJ. Current trends in perioperative antibiotic use: a survey of otolaryngologists. Otolaryngol Head Neck Surg 2015; 152 (01) 63-66
• 16 Ottoline AC, Tomita S, Marques MdaP, Felix F, Ferraiolo PN, Laurindo RS. Antibiotic prophylaxis in otolaryngologic surgery. Int Arch Otorhinolaryngol 2013; 17 (01) 85-91
• 17 Caniello M, Passerotti GH, Goto EY, Voegels RL, Butugan O. Antibiotics in septoplasty: is it necessary?. Rev Bras Otorrinolaringol (Engl Ed) 2005; 71 (06) 734-738
• 18 Andrews PJ, East CA, Jayaraj SM, Badia L, Panagamuwa C, Harding L. Prophylactic vs postoperative antibiotic use in complex septorhinoplasty surgery: a prospective, randomized, single-blind trial comparing efficacy. Arch Facial Plast Surg 2006; 8 (02) 84-87
• 19 Ricci G, D'Ascanio L. Antibiotics in septoplasty: evidence or habit?. Am J Rhinol Allergy 2012; 26 (03) 194-196
• 20 Lange JL, Peeden EH, Stringer SP. Are prophylactic systemic antibiotics necessary with nasal packing? A systematic review. Am J Rhinol Allergy 2017; 31 (04) 240-247
• 21 Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, Magliulo G, Re M. The role of antibiotic therapy and nasal packing in septoplasty. Eur Arch Otorhinolaryngol 2014; 271 (05) 879-886
• 22 Koçak F, Balkan İİ, Çelik AD, Durdu B. Perioperatif antimikrobiyal profilaksi uygulamalarında rehberlere uyum: Çok merkezli bir çalışma. Anat Clin 2017; 22: 8-15
• 23 Langerman A, Thisted R, Hohmann S, Howell M. Antibiotic and duration of perioperative prophylaxis predicts surgical site ınfection in head and neck surgery. Otolaryngol Head Neck Surg 2016; 154 (06) 1054-1063
• 24 Versporten A, Bolokhovets G, Ghazaryan L. et al; WHO/Europe-ESAC Project Group. Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe. Lancet Infect Dis 2014; 14 (05) 381-387
• 25 Kaya S, Aktaş S, Şenbayrak S. et al. An evaluation of surgical prophylaxis procedures in Turkey: a multi-center point prevalence study. Eurasian J Med 2016; 48 (01) 24-28
• 26 Hoşoğlu S, Sünbül M, Erol S. et al. A national survey of surgical antibiotic prophylaxis in Turkey. Infect Control Hosp Epidemiol 2003; 24 (10) 758-761
• 27 Oppelaar MC, Zijtveld C, Kuipers S. et al. Evaluation of Prolonged vs Short Courses of Antibiotic Prophylaxis Following Ear, Nose, Throat, and Oral and Maxillofacial Surgery: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2019; 145 (07) 610-616
• 28 Della Polla G, Bianco A, Mazzea S, Napolitano F, Angelillo IF. Preoperative Antibiotic Prophylaxis in Elective Minor Surgical Procedures among Adults in Southern Italy. Antibiotics (Basel) 2020; 9 (10) 713
• 29 Dubberke ER, Olsen MA. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis 2012; 55 (Suppl 2): S88-S92
• 30 Gyssens IC, Geerligs IE, Dony JM. et al. Optimising antimicrobial drug use in surgery: an intervention study in a Dutch university hospital. J Antimicrob Chemother 1996; 38 (06) 1001-1012
• 31 Manniën J, van Kasteren ME, Nagelkerke NJ. et al. Effect of optimized antibiotic prophylaxis on the incidence of surgical site infection. Infect Control Hosp Epidemiol 2006; 27 (12) 1340-1346