Abstract
Oral third-generation cephalosporins are broad-spectrum antimicrobial agents and constitute one of the most used classes of antibiotics in Japan. The Japanese government introduced the National Action Plan on Antimicrobial Resistance in 2016 and emphasized the necessity of antimicrobial stewardship. Therefore, to promote appropriate use of oral antibiotics in a children’s hospital, we investigated the usage of oral third-generation cephalosporins and found that most of these antibiotics were prescribed for prevention of postoperative surgical site infections (SSIs) in the pediatric urology department. Additional investigations revealed that inappropriate intravenous antibiotics were used to prevent SSIs. Based on these results, we published guidelines on the prevention of SSIs to optimize the use of perioperative antibiotics, and introduced a permission system for using oral third-generation cephalosporins.
We investigated the changes in urological perioperative antibiotic use (days of therapy per 1,000 patients-days: DOT), the incidence of SSIs, and changes in costs pre- and post- intervention.
Regarding perioperative antibacterial drugs, cefotiam DOT decreased from 140.2 to 2.3 and cefazolin DOT increased from 0 to 173.6. Oral third-generation cephalosporin DOT after surgery decreased from 481.4 to 0. Moreover, SSIs did not appear during pre- and post- intervention, and drug costs were declined.
In conclusion, the introduction of guidelines on the prevention of SSIs and a permission system for using oral third-generation cephalosporins was useful for the appropriate use of urological perioperative antibiotics. In addition, it contributed greatly to the improvement of medical service quality by reducing drug costs, and potentially the burden on patients and their families.
