Compliance with guidelines on antibiotic prophylaxis in hip and knee arthroplasty in Italy: results of the GISIO-ISChIA project

Background: The Perioperative Antibiotic Prophylaxis (PAP) contributes considerably to the total amount of antibiotics used in hospitals and has been shown to be associated with increase in antibiotic resistance and healthcare costs. The level of compliance with the national guidelines of current practices of PAP for elective hip and knee prosthesis procedures in a network of Italian hospitals (the multicentre Surgical Site Infection surveillance project GISIO-ISChIA), has been evaluated. Methods: Compliance of the current prophylactic antibiotic practices with the published national guidelines was assessed for each included operative procedure, considering indication, timing of administration, prescribed antimicrobial agent and total duration of prophylaxis. Results: A total of 14 hospitals and 1285 surgical procedures were included. 99.4% of patients received antimicrobial prophylaxis pre-operatively and 73.0% of patients received PAP within the recommended time period (within 60 minutes before incision). The rate of compliance with discontinuation of PAP within 24 hours after initiation of surgery was 70.2%. Taking into account all doses administered, the antibiotic was chosen appropriately in 57.7% of patients. PAP was performed appropriately, in accordance with national guidelines, in 43.6% of surgical operations. Conclusions: Given the increasing number of replacement procedures in Italy and in Europe, the gap between the evidence-based guidelines and practice must be appropriately addressed in order to improve PAP practices.