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.

Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Risk Factors in Older Adult Patients.

Introduction: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has recently gained worldwide interest due to limited treatment options and high morbidity and mortality rates. The aim of this study was to determine the risk factors of carbapenem-resistant K. pneumoniae (CRKP) infection in older adult patients. Material and Methods: This retrospective, single-center study included 132 patients with healthcare-associated CRKP infection (case group) and 150 patients with healthcare-associated carbapenem-susceptible K. pneumoniae (CSKP) infection (control group), aged > 65 years. Results: In the CRKP and CSKP groups, 79 (59.8%) and 80 (53.3%) patients were males, and the mean ages were 77.8 ± 7.8 and 76.6 ± 7.7 years, respectively. Diabetes mellitus (DM), malignancy, cardiovascular diseases (CVDs), surgical intervention, invasive mechanical ventilation, central venous catheter insertion, parenteral nutrition, hospitalization in the previous 6 months, antibiotic use in the previous 3 months, and exposure to cephalosporins, fluoroquinolones, and carbapenems were significantly more common in the CRKP than the CSKP group (all p < 0.05). The multivariate logistic regression analysis identified malignancy, CVDs, DM, invasive mechanical ventilation, hospitalization in the previous 6 months, ICU admission, and exposure to cephalosporins, quinolones, and carbapenems as independent risk factors for CRKP infection in older adult patients. Conclusion: DM, malignancy, CVDs, ICU admission, invasive mechanical ventilation, and exposure to ceftriaxone, fluoroquinolones, and carbapenems were independent risk factors for CRKP infection in older adult patients. The identification of risk factors for CRKP infection can help to prevent and treat CRKP infection.