Antibiotic Prophylaxis: What is the Quality of Reporting of Studies of Interventions to Increase Compliance? Interview with: Lillian S. Kao, MD, MS
Associate Professor, Department of Surgery
The University of Texas School of Medicine at Houston
Houston, Texas 77030 What are the main findings of the study?

Dr. Kao:

-The internal validity (methodological rigor) and external validity (generalizability) of quality improvement (QI) studies of implementation of surgical antibiotic prophylaxis measures are poor.

-Studies demonstrating large positive effect on compliance were often performed in settings where the baseline compliance was extremely low (i.e., less than 20%), thus further limiting their generalizability.

-Very few studies evaluated the effect of the QI interventions to increase appropriate antibiotic prophylaxis use on surgical site infections (SSIs). Moreover, those studies that included SSI as an outcome measures were usually underpowered to identify a significant effect.

-The majority of studies failed to report metrics relating to the quality of the implementation of the interventions to increase antibiotic prophylaxis compliance. Effectiveness of evidence-based measures is dependent upon their implementation. For example, did all of the targeted groups adopt the intervention? Or were the QI interventions sustained beyond the initial measurement or study period? What should clinicians and patients take away from your report?

Dr. Kao:

-Clinicians seeking to implement interventions to improve surgical antibiotic prophylaxis should measure not only compliance with the prophylaxis measures but also implementation of the intervention. Despite the poor methodological quality of the studies, most showed an improvement in compliance. However, no single intervention or combination of interventions was universally effective; thus, the intervention should be tailored to the local context.

-Patients should be aware that the findings should not discourage clinicians to engage in QI efforts to improve compliance with surgical antibiotic prophylaxis. Even if compliance or SSIs do not appear to be altered, QI interventions such as checklists may result in improved safety culture or other positive changes that are not currently measured in these studies. What recommendations do you have for future research as a result of this study?

Dr. Kao:

-Future research should focus on understanding what contextual factors improve uptake of interventions to increase compliance with evidence-based measures.

What is the Quality of Reporting of Studies of Interventions to Increase Compliance with Antibiotic Prophylaxis?

Shauna M. Levy, Uma R. Phatak, KuoJen Tsao, Curtis J. Wray, Stefanos G. Millas, Kevin P. Lally, Lillian S. Kao

Journal of the American College of Surgeons – 08 July 2013 (10.1016/j.jamcollsurg.2013.06.018)