Innapropriate prescribing of antibiotics which are indicated for the treatment of postoperative infections in neurosurgery

Inappropriate antibiotic prescribing is the most important predictor for manifested negative clinical and economic treatment outcomes. The problem is more complex in the population with postoperative infections in neurosurgery, prevalence is increasing despite the implemented prophylaxis. The aim of this study was to perform a descriptive analysis of inappropriate prescribing of empiric antibiotics for treatment of central nervous system infections and surgical wound infections after neurosurgery. The study was designed as a retrospective cross-sectional study. From the total included population (n=136), cases were analyzed (n=78) in which at least 1 pattern of inappropriate antibiotic prescribing - misprescribing or underprescribing - was identified. Patients with meningitis (n=26), intracranial abscess (n=17) and surgical wound infections (n=35) were included. Misprescribing was identified by Medication Appropriateness Index tool in 69 (88.5%) patients whose use at least one antibiotic was evaluated with MAI score ≥4, while underprescribing was observed in 52 (66.7%) respondents. The most common inappropriately prescribed antibiotics were meropenem in 16 cases, and colistin, metronidazole and ceftriaxone in 11 cases. The most common reasons for inappropriate prescribing included inadequate choice of drug 77 (49.7%), inappropriate length of treatment 78 (50.3%), and inadequate costs 75 (48.4%). Underprescribing was confirmed in 36 cases for use of vancomycin and in 19 for the use of meropenem. Based on above results we can conclude that there is need for increased attention when evaluating empiric antimicrobial therapy and need to create local guidelines for empiric therapy based on epidemiological data on causative agents of observed infections and their harmonization with international recommendations.