보건복지부 영문홈페이지

Are preventive antibiotics being well used in surgeries?

- The use of antibiotics has greatly reduced over the past 4 years, but there are still large gaps among hospitals.

Health Insurance Review & Assessment Service (HIRA, President Kang, Yoon Koo) disclosed the result of the assessment of the use of antibiotics in surgeries for the purpose of prevention of infection regarding 11 kinds of surgeries selected considering the amount of antibiotics used, the number of operations, and improvement effects, etc.   

There are two major reasons why antibiotics are needed in surgeries for the purpose of prevention. First, it is to enhance quality of medical care by reducing treatment cost and hospitalization duration through the prevention of surgical site infection, which is the second or third largest nosocomial infection. Second, it helps alleviate antibiotics resistance caused by unnecessary use of antibiotics.

The result of the survey on the use of antibiotics in surgeries in 2005 indicates that antibiotics are excessively used.  

※ The result of 2005 Survey: the rate of antibiotics administered within one hour before the surgery: 11.1%, the rate of suspension within 24 hours: 0.2%, the average no. of days of administration: 12.3 days, the joint administration rate: 42.3%, the rate of the third generation cephalosporin administration: 68.7%

HIRA has been conducting an assessment of the use of preventive antibiotics in surgeries every year starting from 2007 as a part of the control actions against the increase of antibiotics resistance resulting from the unnecessary use of antibiotics and for the purpose of prevention of surgical site infections.

The assessment was made on the three areas; the initial injection of antibiotics, the choice of antibiotics and the administration duration. There have been improvements on the all three areas, leading to a great reduction in the use of antibiotics.

Initial injection of antibiotics: The greatest improvement is shown in this area as the percentage changed from 23.6% in 2006, which was before the assessment to 80.7% in 2010.

Choice of antibiotics: The administration rate of aminoglycoside antibiotics, which is not recommended as preventive antibiotics, reduced from 68.4% before the assessment to 19.3% in 2010 and the administration rate of the 3^rd and higher-generation cephalosporins decreased from 48.5% before the assessment to 7.0% in 2010. The rate of using multiple kinds of antibiotics also went down from 84.4% to 29.5%.

Administration duration: The number of days of administration after the surgery when there is no infection occurred after the surgery decreased from 11.5 days to 5.8 days by 50% along with the reduction of the rate of antibiotics preion at the time of a patient’s discharge from hospital.

The use of antibiotics per surgery in the existing subject surgeries went down by 41.1% compared to 2006, which was before the assessment due to a reduction in the number of days of administration and the undesirable use of antibiotics.

The use of antibiotics was also reduced by 35.9% compared to the previous year for the newly added subjects, on which the assessment began from 2010.

The use of antibiotics in the subject surgeries greatly decreased compared to the non-subject surgeries.

*Initial injection of antibiotics

* Choice of antibiotics

*Administration duration

*Use of antibiotics

※ Initial injection of antibiotics: The higher, the better

Choice of antibiotics and administration duration: The lower, the better

Initial injection of antibiotics, choice of antibiotics, and administration duration: The result for 2010 includes figures for the new surgeries.

The result for 2006 is a preliminary assessment result.

Non-subject surgeries: vascular surgery, Hernia surgery, and appendectomy

Use of antibiotics per surgery: DDD (Defined Daily Dose) per case

To sum up the results in the three areas, 104 (24.9%) institutions show 90% and higher and 44 organizations (10.5%) display less than 80~90 % while 48 institutions (11.5%), less than 30%. Among the organizations that show below 30% are twelve hospitals and 36 clinics.

※ Status of medical institutions by range as a comprehensive result

(Unit: %, organization)

Although there have been obvious improvement overall, the results from some small and medium sized clinics still fall short of the expectations.

In order to enhance quality of low-grade institutions, the disclosure of the hospital assessment results and the customized consulting service for quality enhancement, etc have been done. From next year, a merit-based incentive program will be executed, in which incentives will be given to those showing good and improved results and disincentives will be given to those displaying low grades.

Also, the assessment subject surgeries will be extended from 11 surgeries to all the concerned surgeries and the assessment itself will change from the preventive antibiotics assessment to the nosocomial infection management assessment.  

The results of this assessment can be found at the website of Health Insurance Review and Assessment Service (www.hira.or.kr/).

※ The presentation to explain the assessment result and the merit-based incentive program to be held from 14 Dec. to 16 (in five areas)