A Survey on Antimicrobial Prescriptions and Stewardship Programs in Korea

Bang, Ji Hwan; Song, Kyoung Ho; Park, Wan Beom; Kim, Sung Han; Cho, Jae Hyun; Kim, Hong Bin; Kim, Nam Joong; Oh, Myoungdon; Choe, Kang Won

Abstract

BACKGROUND: Previous studies in Korea showed that unnecessary antibiotic use could not be neglected, especially in prophylactic use. Currently many hospitals employ diverse antibiotic stewardship programs, but there are few studies on surveillance of such programs. So, we planned this study to evaluate current status of antimicrobial stewardship and adequacy of antimicrobial prophylaxis in surgery.
MATERIALS AND METHODS
We sent questionnaires about policy on antibiotic usage, control program for adequate antibiotic prescription, and actual status of prophylactic antibiotic usage to 55 infectious disease physicians in each hospital.
RESULTS
Of 55 contacted infectious diseases clinicians, 44 answered the questionnaire. Majority of hospitals employed restricted antimicrobial system (95.5%), education (79.5%), control by order communicating system (59.1%), consult to infectious disease physicians (59.1%), and review of cumulative antimicrobial usage (52.3%) to prevent inadequate antibiotic use. Glycopeptides were designated as a restricted antimicrobial agent in 100.0% of hospitals; carbapenems, 93.0%; quinupristin/ dalfopristin or linezolid, 93.0%; the 4th generation cephalosporins, 74.4%; caspofungin or voriconazole, 62.8%; liposomal amphotericin B, 60.5%, and so on. Unnecessary perioperative prophylactic antimicrobial agents were prescribed in gastrectomy and mastectomy in all the hospitals. The second generation cephalosporins and the third generation cephalosporins were the most commonly prescribed prophylactic antimicrobial agents in total knee replacement arthroplasty (TKRA) and coronary artery bypass graft surgery (CABG) respectively. In 70.5% of institutes they use prophylactic antimicrobial agents more than four days in gastrectomy; 63.6% in mastectomy; 81.8% in TKRA; 81.1% in CABG. Unnecessary combination of aminoglycosides with other antimicrobial agents for prophylactic use was another common problem.
CONCLUSION
This study shows that more effort is required to diminish antimicrobial misuse or overuse, especially in prophylactic use for surgical patients.