Predictors of inappropriate perioperative antibiotic prophylaxis duration: a cohort study in Italy

This is the authors' abstract. We don't add key points for this paper.

Background Perioperative antibiotic prophylaxis (PAP) is a cornerstone of surgical infection prevention. Inappropriate duration (courses exceeding 24 hours) is a relevant quality indicator for prescribing practices. Identifying patient-level and procedure-level factors associated with non-compliant PAP duration is key to designing effective, targeted antimicrobial stewardship interventions. Methods All 34 public hospitals and 3 private hospitals of the Region of Piedmont, in Northen Italy, were included. Data on PAP were prospectively collected through the Italian Surgical Site Infection Surveillance Programme (SNICh2) regarding the year 2024. A multivariate logistic regression was performed with PAP duration exceeding 24 hours as the dependent variable and gender, age and American Society of Anesthesiologists (ASA) classification as independent variables, overall and stratified by surgical category. Results Of the 9,489 monitored procedures in which PAP was administered, 632 cases (6.66%) had a PAP duration exceeding 24 hours. Logistic regression suggested, in the overall model, that patients under 75 years of age were significantly less likely to receive inappropriately prolonged PAP (OR 0.81, p = 0.003); significant differences were found according to procedure category. Regarding cardiac surgery procedures, ASA 1-2 patients were less likely to receive PAP exceeding 24 hours (OR 0.29, p = 0.049). Elective surgery was associated with reduced non-compliance to PAP duration in colorectal surgery procedures (OR 0.51 p < 0.001) and in hip prosthesis procedures (OR 4.36 p < 0.001). Conclusions This study identified surgical categories and patient predictors where stewardship efforts should be focused. In line with European action plans on antimicrobial resistance, integrating surveillance data into hospital stewardship programmes is a key element to promote rational antibiotic use. Key messages • Targeted stewardship programmes addressing specific surgical categories and patient profiles are required to reduce inappropriate prophylaxis duration and curb resistance. • In 6.66% of monitored surgical procedures, antibiotic prophylaxis exceeded 24 hours; age, ASA class and procedure type were identified as key predictors of non-compliance.