•  
  •  
 

Abstract

Inappropriate use of prophylactic antibiotics (PAs) remains a primary driver of antimicrobial resistance (AMR); however, global adherence to established prescribing guidelines remains suboptimal. This study aimed to analyze the compliance and rationality of PA prescription and to evaluate the underlying causes of physician non-adherence in obstetrics, orthopedic, and gastrointestinal surgeries at a hospital in South Tangerang City, Indonesia. Adopting a mixed-methods approach, this investigation combined a quantitative assessment of 208 surgical patient records (January–March 2024) with qualitative exploratory interviews conducted with three specialist peer group heads. This design allowed the triangulation of prescribing data with underlying clinical perspectives. PA rationality was assessed based on four criteria: indication, agent type, timing, and duration. Univariate analysis was used to examine the relationship between physician characteristics and compliance. The qualitative findings were analyzed using the Capability, Opportunity, Motivation – Behavior (COM-B) behavioral model. Overall compliance with all four PA criteria was poor, at only 9% (18 of 208 surgeries). Low adherence was particularly noted in agent selection (33%) and administration timing (42%). Orthopedic surgery showed the lowest compliance in terms of indication and duration. Univariate analysis indicated that only surgical procedure type significantly influenced compliance (p = 0.039). Qualitative analysis revealed that non-adherence was primarily driven by the fear of surgical site infection (SSI) and the belief that broad-spectrum agents are more effective. Notably, despite poor compliance, no incidence of SSI (0%) was reported during the 30–90-day post-procedure follow-up. Consistently poor compliance highlights significant gaps in procedural implementation and physician motivation regarding reasonable PA use. Targeted interventions focusing on standardized procedures, evidence-based education, and systemic monitoring are essential to improve prescription practices and mitigate the risk of AMR development.

References

  1. Boban D, Kaur K, Singh SK. Combating AMR—One Health Approach. In: Saroj SD, editor. Antimicrobial Resistance Collaborative Measures of Control. First edition. New York: CRC Press; 2023. p. 311–328.
  2. Broom J, Broom A, Kirby E, Post JJ. Improvisation versus guideline concordance in surgical antibiotic prophylaxis: a qualitative study. Infection. 2018;46(4):541–548.
  3. Cardwell SM, Root A, Halliday A. Antimicrobial Stewardship in Ambulatory Surgery Center. In: Doron S, Campion M, editors. Antimicrobial Stewardship in Non-Traditional Settings. Boston: Springer; 2023. p. 85–104.
  4. Surat G, Meyer-Sautter P, Rüsch J, Braun-Feldweg J, Markus CK, Germer C, et al. Cefazolin might be adequate for perioperative antibiotic prophylaxis in intra-abdominal infections without sepsis: a quality improvement study. Antibiotics. 2022;11(501).
  5. Ierano C, Rajkhowa A, Peel T, Marshall C, Ayton D, Thursky K. Antibiotic prescribing in surgery: a clinically and socially complex problem in Australia. Infectious Diseases & Health. 2020;25(4):309–313.
  6. Sadli NK, Halimah E, Winarni R, Widyatmoko L. Implementasi rasionalitas penggunaan antibiotik pada beberapa rumah sakit di Indonesia: kajian literatur mengenai kualitas dan tantangannya. Jurnal Sains Farmasi dan Klinis. 2022;9(3):227–236.
  7. Muller A, Leroy J, Henon T, Patry I, Samain E, Chirouze C, et al. Surgical antibiotic prophylaxis compliance in a university hospital. Anaesthesia Critical Care & Pain Medicine. 2015;34:289–294.
  8. Valeska J, Sobalvarro M, Alves A, Júnior P, Borges L. Antimicrobial stewardship for surgical antibiotic prophylaxis and surgical site infections: a systematic review. International Journal of Clinical Pharmacy. 2022;44(2):301–319.
  9. Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 28 Tahun 2021 Tentang Pedoman Penggunaan Antibiotik. Jakarta: Kementerian Kesehatan RI; 2021.
  10. Farrell S, Benson T, McKernan C, Burrell AMG, Dean M. Exploring veterinarians' behaviour relating to antibiotic use stewardship on Irish dairy farms using the COM-B model of behaviour change. Research in Veterinary Science. 2023;156:45–53.
  11. Acampora M, Paleologo M, Graffigna G, Barello S. Uncovering influential factors in human antibiotic prescribing: a meta-synthesis study informed by the Theoretical Domains Framework. Journal of Hospital Infection. 2024;144:28–55.
  12. Acampora M, Guasconi M, Schiroli C, Coschignano C, Cassinari N, Cipolla R, et al. Uncovering doctors' perceived barriers and facilitators of antibiotic prescribing behaviours: a qualitative study using the Theoretical Domains Framework. Acta Biomedica. 2023;94(6).
  13. Giusti A, Alegiani SS, Luisa M, Colaceci S, Raschetti R, Arace P, et al. Surgical antibiotic prophylaxis in children: a mixed-method study on healthcare professionals’ attitudes. BMC Pediatrics. 2016;16(203):1–8.
  14. Willmott TJ, Pang B, Rundle-Thiele S. Capability, opportunity, and motivation: an across-contexts empirical examination of the COM-B model. BMC Public Health. 2021;21(1014):1–17.
  15. Greene C, Wilson J. The use of behaviour change theory for infection prevention and control practices in healthcare settings: a scoping review. Journal of Infection Prevention. 2022;23(3):108–117.
  16. Chiu C-Y, Chen S, Chen C-L. An integrated perspective of TOE framework and innovation diffusion in broadband mobile applications adoption by enterprises. International Journal of Management, Economics and Social Sciences. 2017;6(1):14–39.

Bahasa Abstract

Penggunaan antibiotik profilaksis (AP) yang tidak tepat merupakan kontributor signifikan terhadap peningkatan resistensi antimikroba (Antimicrobial Resistance/AMR). Kendati demikian, tingkat kepatuhan terhadap pedoman penggunaan AP dalam praktik klinis secara global masih tergolong rendah. Penelitian ini bertujuan untuk menganalisis kepatuhan dan rasionalitas resep AP serta mengevaluasi akar penyebab ketidakpatuhan dokter dalam operasi obstetri, ortopedi, dan gastrointestinal di sebuah rumah sakit di Kota Tangerang Selatan, Indonesia. Penelitian ini menerapkan desain metode campuran (mixed-methods), yang mengintegrasikan analisis kuantitatif terhadap 208 rekam medis pasien bedah selama periode Januari–Maret 2024 dengan studi kualitatif eksploratif melalui wawancara mendalam bersama tiga ketua kelompok staf medis (KSM) spesialis. Rasionalitas AP dinilai berdasarkan empat kriteria: indikasi, jenis agen, waktu pemberian, dan durasi. Analisis univariat menguji hubungan antara karakteristik dokter dan kepatuhan. Temuan kualitatif dianalisis menggunakan model perilaku Capability, Opportunity, Motivation – Behavior (COM-B).  Kepatuhan keseluruhan terhadap keempat kriteria AP sangat rendah, yaitu hanya 9% (18 dari 208 operasi). Kepatuhan yang rendah secara khusus tercatat pada pemilihan jenis agen (33%) dan waktu pemberian (42%). Operasi ortopedi menunjukkan kepatuhan terendah pada indikasi dan durasi. Analisis univariat menunjukkan bahwa hanya jenis prosedur bedah yang secara signifikan memengaruhi kepatuhan (p = 0.039). Analisis kualitatif mengungkapkan bahwa ketidakpatuhan didorong oleh kekhawatiran terhadap Infeksi Daerah Operasi (IDO) dan keyakinan bahwa agen spektrum luas lebih efektif. Meskipun kepatuhan buruk, tidak ada insiden IDO (0%) yang dilaporkan selama periode tindak lanjut 30–90 hari pasca-prosedur. Tingkat kepatuhan yang secara konsisten rendah menyoroti kesenjangan signifikan dalam implementasi prosedural dan motivasi dokter terkait penggunaan AP yang rasional. Intervensi yang ditargetkan, berfokus pada prosedur terstandardisasi, edukasi berbasis bukti, dan pemantauan sistemik, sangat penting untuk meningkatkan praktik peresepan dan memitigasi risiko perkembangan AMR.

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.