EP 669 Postoperative Antibiotic Stewardship in General Surgery: Compliance with NICE NG125 Guidelines
Altaf Haji, Vanojan Juwanwarnag, Ali Butt, Ali Mohamed, Aleksandra Laguna, Bala PiramanayagamAbstract
Background
NICE guideline NG125 recommends that postoperative antibiotics are used only when infection is present, prophylactic antibiotics are discontinued within 24 hours, treatment is reviewed early, IV antibiotics are switched to oral promptly, & microbiology advice is sought for prolonged courses. This audit assessed compliance with NICE NG125 in our practice at DGH.
Methods
A retrospective audit of 60 adult general surgical patients over a two-month period was conducted. Data was collected & assessed against NG125-aligned standards, including documentation of indication, duration of therapy, timing of review, IV-to-oral switch, & microbiology involvement for antibiotic courses exceeding five days. Elective/ emergency surgery were compared, & multivariable logistic regression was used to identify predictors of inappropriate antibiotic use.
Results
Postoperative antibiotics were prescribed in 66.7% of patients (70% elective, 30% emergency). Compliance with NICE NG125 standards was poor. A clear indication for antibiotics was documented in 80% of cases. Only 30% of prophylactic antibiotics were discontinued within 24 hours. IV antibiotics were reviewed within 48 hours in 65% of patients, and IV-to-oral switch within 72 hours occurred in 75% of eligible cases. Microbiology input for antibiotic courses longer than five days was documented in only 8.3%. Therapeutic antibiotic use for sepsis or peritonitis was more appropriate in emergency surgery than elective surgery (55.6% vs 19.0%; p = 0.004). Prolonged prophylactic antibiotic use was more common following elective surgery (47.6% vs 22.2%; p = 0.048).
Conclusion
Compliance with NICE NG125 was poor, especially in elective surgery, with unnecessary prolonged prophylaxis and delayed review requiring targeted stewardship.