VICNISS - Choice of Antibiotics

The tables below present the percentage of procedures each year which were compliant with guidelines for choice of antibiotic in Victoria. The number in parentheses underneath the procedure group (n=) is the total number of procedures in the dataset.

Percentage compliance with recommendations for antibiotic choice, Large hospitals (> 100 acute beds)

Reporting period	Cardiac (n=14,918)%	Caesareans (n=39,441)%	Colon surgery (n=5,409)%	Hysterectomy (n=2,122)%	Herniorraphy (n=1,618)%	Orthopaedic (n=39,176)%
2003–04	96	86	72	41	80	90
2004–05	97	90	79	49	34	97
2005–06	87	90	84	46	53	97
2006–07	91	90	79	40	64	98
2007–08	93	91	77	39	68	97
2008–09	97	92	94	35	76	98
2009–10	98	95	86	52	63	98
2010–11	98	96	85	57	78	98
2011–12	99	96	88	68	94	98

Percentage compliance with recommendations for antibiotic choice, Smaller hospitals (< 100 acute beds)

Reporting period	Caesareans (n= 1,458)%	Cholecystectomy (n=1,996)%	Colorectal (n=1,020)%	Hysterectomy (n=1,252)%	Hernia repair (n=2,982)%	Orthopaedic (n=1,282)%
2004–05	82	79	73	38	33	91
2005–06	90	82	71	25	71	96
2006–07	81	85	85	54	85	98
2007–08	76	82	81	39	88	99
2008–09	94	76	84	36	90	98
2009–10	89	75	86	45	92	97
2010–11	94	89	81	46	95	99
2011–12	95	96	87	55	97	100

Data for hysterectomies is consistently lower than for other procedure groups. The most likely explanation is that there is a lack of international consensus regarding the recommended antibiotics for this type of surgery compared with other surgery groups. Australian guidelines recommend administration of two antibiotics (a cephalosporin plus metronidazole) whereas US and Canadian guidelines recommend only a cephalosporin.

The evidence for use of two antibiotics is currently based on covering the expected microbial flora of the region and no antibiotic has so far been shown to be superior. Almost all of the surgeries performed in Victoria deemed to have been non-compliant have been categorised this way due to administration of a cephalosporin alone.

The VICNISS Coordinating Centre has been approached by gynaecologists and other interested parties regarding this issue and has referred these parties to the authors of the Therapeutic Guidelines Antibiotic¹, which is reviewed every 2 years.

¹ Antibiotic Expert Group 2010, Therapeutic guidelines: antibiotic, version 14, Therapeutic Guidelines Limited, Melbourne, www.tg.org.au/index.php?sectionid=41, accessed 1 October 2013