2020 年 46 巻 6 号 p. 287-295
In 2016, the Japanese Society of Chemotherapy and Japanese Society for Surgical Infection jointly issued the “Japanese Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery” (hereinafter referred to as guidelines). The Infection Control Committee of the Gifu Prefectural Society of Hospital Pharmacists conducted a survey to clarify the current status of the perioperative clinical pathway (CP) and the intervention of antimicrobial stewardship team (AST) at various medical institutions in Gifu Prefecture. Furthermore, the said survey aimed to promote the appropriate use of antimicrobial prophylaxis during surgery. Of the 23 hospitals surveyed, 22 hospitals created CP (average 408 licensed beds), and the total number of CPs was 378. The rates of compliance with the CP guidelines were 76.2％ for antibiotic selection, 50.0％ for administration duration, and 42.1％ for both antibiotic selection and administration duration. Lower rates of compliance were observed for the treatment duration rather than for the choice of antimicrobials. Moreover, the AST intervention rate for CP was 36.4％. In addition, we evaluated the effects of antimicrobial stewardship (AS) on guideline compliance. In the univariate analysis, 604 or more beds, AST intervention, AS of pharmacists of more than 23 hours/week, and 4.8 or more pharmacists/100 beds were significant factors for compliance with the CP guideline. Additionally, multivariate analysis showed that AST intervention and AS of pharmacists of more than 23 hours/week were independent factors affecting CP guideline compliance. In conclusion, playing an active role for improvement of CP by AST pharmacists can promote the optimization of antimicrobial prophylaxis in surgery.
