engleski

Chemoprophylaxis in general surgery departments in Croatia and Greece

Background: Application of peri-operative parenteral chemoprophylaxis is essential for the prevention of post-operative infections. In order to insure a successful and reasonable chemoprophylaxis, national and international organizations have proposed guidelines for appropriate prophylactic antibiotic usage. The aim of the present study was to compare the status of Chemoprophylaxis in General Surgery Departments of two University Hospitals in Croatia and in Greece, and to check if current recommended guidelines for Surgical Chemoprophylaxis are met. Methods: Two University Surgery Departments participated the study: the General and Abdominal Surgery Clinics of the University Hospital of Rijeka (Croatia) and the 5th University General Surgery Department of the Hippokrateion Hospital of Thessaloniki (Greece). The surgeons of the Croatian and the Greek Surgery Departments replied to the same questionnaire, which investigated the conformance to the current guidelines and the behavior of the surgeons in Surgical Chemoprophylaxis in clean and in clean contaminated surgery, and in patients having a low or a high risk for a post-operative infection. The following issues in Chemoprophylaxis were checked: 1) application of chemoprophylaxis, 2) duration and time of initiation of chemoprophylaxis and 3) the kind of antibiotics used. Results: 1) Application of chemoprophylaxis: According to the guidelines, neither the Croatian nor the Greek surgeons applied chemoprophylaxis in low risk patients undergoing a clean surgery. In high risk patients undergoing a clean surgery, the Croatian surgeons used chemoprophylaxis only exceptionally, while the Greek surgeons used chemoprophylaxis in all cases. In clean contaminated surgery, the Greek surgeons used chemoprophylaxis in all cases, while the Croatian surgeons used chemoprophylaxis in all operations of esophagus, stomach, jejuni and colon, and in high danger surgery of small intestine. In laparoscopy, the Greek surgeons used chemoprophylaxis in all cases, while the Croatian surgeons used chemoprophylaxis only in high danger patients. 2) The duration of chemoprophylaxis was: a) less than 24 hours in clean operations, in operations of diaphragmatic hernia and spleen, and in low danger operations of stomach, jejuni, small intestine, bile vessels and pancreas ; b) more than 24hours in all operations of esophagus and colon, and in high danger operations of small intestine, bile vessels and pancreas. In high danger operations of stomach and jejuni, the duration of chemoprophylaxis was less than 24hours in the Croatian Hospital but more than 24 hours in the Greek Hospital. Chemoprophylaxis was always initiated during the induction to anesthesia, except for esophagus surgery, in which the Croatian surgeons initiated chemoprophylaxis 2 days before the operation and continued it for 2 days after the operation. 3) The beta lactams most commonly used by the Croatian surgeons were aminopenicillin, cefazolin and cefuroxime, while the beta-lactams most commonly used by the Greek surgeons were second generation cephalosporins or aminopenicillin or aminopenicillin plus beta-lactamase inhibitor or carboxypenicillin plus beta-lactamase inhibitor. Metronidazole was used for chemoprophylaxis in operations of small intestine and colon. The Croatian surgeons used also gentamicin in thyroid, parathyroid and hernia surgery. Conclusions: Although both Greek and Croatian surgeons try to keep a good discipline in following the guidelines for parenteral peri-operative chemoprophylaxis, discrepancies are observed in the application, the duration, the time of initiation and the kind of chemoprophylaxis used. Greek surgeons apply chemoprophylaxis in clean surgery, when the patient is in high risk for a post-surgical infection. Croatian surgeons use gentamicin in thyroid, parathyroid and hernia surgery and they initiate chemoprophylaxis two days in advance in operations of esophagus. In many cases, both groups of surgeons continue chemoprophylaxis for more than the maximum suggested time of 24 hours.

surgical prophylaxis; antibiotis

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