Surgical Antimicrobial Prophylaxis Compliance in Turkey: Data from the Prospective, Observational, Multicenter Survey Including 7,978 Surgical Patients.

Background: Surgical antimicrobial prophylaxis (SAP) is the peri-operative administration of antimicrobial agents. Compliance rates vary worldwide from 15% to 84.3%, with studies in Turkey not exceeding 35%. The aim of this multicenter study was to determine the rate of appropriate antibiotic class, timing, and duration as well as discharge prescriptions in Turkey. Thus, we aimed to determine the rate of full compliance with SAP procedures in our country Patients and Methods: This multicenter, prospective, observational, descriptive study was conducted in 47 hospitals from 28 provinces in seven different regions of Turkey. Patients over 18 years of age in all surgical units between June 6, 2022, and June 10, 2022, were included in the study. Results: Of the 7,978 patients included in the study, 332 were excluded from further analyses because of pre-existing infection, and SAP compliance analyses were performed on the remaining 7,646 cases. The antibiotic most commonly used for SAP was cefazolin (n = 4,701; 61.5%), followed by third-generation cephalosporins (n = 596; 7.8%). The most common time to start SAP was within 30 minutes before surgery (n = 2,252; 32.5%), followed by 30 to 60 minutes before surgery (n = 1,638; 23.6%). Surgical antimicrobial prophylaxis duration was <24 hours in 3,516 (50.7%) patients and prolonged until discharge in 1,505 (21.7%) patients. Finally, the actual proportion of patients compliant with SAP was 19% (n = 1,452) after omitting 4,458 (58.3%) patients who were prescribed oral antibiotic agents at discharge as part of a prolonged SAP. Conclusions: Surgical antimicrobial prophylaxis compliance rates are still very low in Turkey. Prolonged duration of SAP and especially high rate of antibiotic prescription at discharge are the main reasons for non-compliance with SAP.

Barriers Against Hepatitis B Vaccination in High-Risk Adults: A Cross-Sectional Study.

BACKGROUND: The hepatitis B vaccination has been strongly recommended by regulatory bodies. However, there are great discrepan- cies between routine practices and the recommendations of regulatory agencies in many countries. We aimed to identify the barriers against Hepatitis B Vaccination (HBV) for high-risk patients by comparing the awareness, attitude, and knowledge among vaccinated and unvaccinated patients. METHODS: A 34-item questionnaire was applied to 156 patients, consisting of renal transplant recipients, allogeneic hematopoietic stem cell transplant recipients, and patients with chronic hepatitis C. Multiple logistic regression analysis was employed to identify indepen- dent predictors for patients receiving the hepatitis B virus vaccination. RESULTS: The multiple logistic regression analysis revealed that the independent risk factors against the HBV vaccination were a require- ment of a separate appointment for hepatitis B virus vaccination (aOR: 3.35, 95% CI, 1.18-9.47), and fear of severe side effects that can be related with hepatitis B virus vaccination (aOR: 3.67, 95% CI, 1.18-9.47). However, taking a recommendation for hepatitis B virus vaccination at least once from a health care provider (aOR: 0.04, 95% CI, 0.01-0.11), and having a health insurance (aOR: 0.09, 95% CI, 0.01-0.55) were independent protective factors for being vaccinated. In further analysis among patients with at least a single dose of vaccine, the lack of recommendation from a health care provider for hepatitis B virus vaccination and the absence of a healthcare pro- vider who is responsible for monitoring the completion of the 3-dose vaccination were identified as independent risk factors for failure to complete the 3-dose hepatitis B virus vaccination. CONCLUSION: In high-risk adults, the barriers against hepatitis B virus vaccination should be handled by a comprehensive action plan to achieve the WHO 2030 hepatitis elimination target.