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KNOWLEDGE AND ATTITUDES OF SURGEONS ON THE USE AND STEWARDSHIP OF PROPHYLACTIC ANTIBIOTICS

Year 2023, Volume: 26 Issue: 2, 379 - 392, 23.06.2023

Abstract

This study aimed to examine the reasons for using and not using surgical antibiotic prophylaxis (SAP), the reasons for inappropriate use, and the opinions and recommendations of the surgeons working in two public hospitals on the use of antibiotics. For this purpose, a questionnaire consisting of open and closed-ended questions developed using the literature was used. Between February 5 and September 6, 2019, when the research was carried out, 54 surgeons from a total of 58 surgeons working in these hospitals were reached and the questionnaire was applied one-to-one. Surgeons mostly rely on the recommendations of books or scientific articles (25.4%). They stated that avoidance of increasing the postoperative infection rate the most in their decision to apply SAP (8.3±2) and the fact that the conditions that fully comply with the information sources (5.9±3.7) were effective in their decision not to apply SAP. Most surgeons stated that they see the inappropriate use of SAP as a major problem and that inappropriate use is mostly due to unnecessary prophylaxis. 75.9% of surgeons think that an antibiotic management program is necessary. In a possible program, it is recommended to use the toolkit and antibiogram package as a strategy to monitor the use and provide feedback and to determine patient risk stratification as a tool. It is thought that the research findings will help the development of antibiotic management and education programs to improve antibiotic use. Also, the results obtained will be beneficial for the antibiotic control team or antibiotic management program planned to be established in hospitals. There is a need for training programs specifically targeting surgeons.

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References

  • Abdel-Aziz, A., El-Menyar, A., Al-Thani, H., Zarour, A., Parchani, A., Asim, M., El-Enany, R., Al-Tamimi, H., & Latifi, R. (2013). Adherence of surgeons to antimicrobial prophylaxis guidelines in a tertiary general hospital in a rapidly developing country. Advances in Pharmacological Sciences, 2013, 1-6.
  • Ahmed, A. M., Nasr, S., Ahmed, A. M., & Elkhidir, O. (2019). Knowledge, attitude and practice of surgical staff towards preoperative surgical antibiotic prophylaxis at an academic tertiary hospital in Sudan. Patient Safety in Surgery, 13(1), 1-6.
  • Badar, V., Parulekar, V. V., & Garate, P. (2018). Study of knowledge, attitude and practice amongst medical professionals about antimicrobial stewardship in tertiary care teaching hospital in India: a questionnaire-based study. International Journal of Basic & Clinical Pharmacology, 7(3), 511.
  • Baniasadi, S., Alaeen, Z., & Shadmehr, M. B. (2016). Surgical antibiotic prophylaxis: a descriptive study among thoracic surgeons. Tanaffos, 15(3), 154.
  • Barlam, T. F., Cosgrove, S. E., Abbo, L. M., MacDougall, C., Schuetz, A. N., Septimus, E. J., et al. (2016). Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 62(10), e51–e77.
  • Binown, K. A., Alhabradi, F. A., Aljahani, A. M., & Shadid, A. M. (2021). Saudi orthopedic surgeons’ knowledge, attitude, and practice regarding surgical antibiotic prophylaxis. Journal of Musculoskeletal Surgery and Research, 1-11.
  • Bohnen, J. M. (2003). Why do surgeons not comply with “best practice”?. Canadian Journal of Surgery, 46(4), 251-2.
  • Centers for Disease Control and Prevention. (2014). Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: US Department of Health and Human Services, CDC.
  • Centers for Disease Control and Prevention. (2019). Antibiotic Use in Hospitals, 2017, Antibiotic Use by Healthcare Setting. Accessed 09 April 2020, https://www.cdc.gov/antibiotic-use/stewardship-report/hospital.html.
  • Crader, M. F., & Varacallo, M. (2019). Preoperative Antibiotic Prophylaxis. Treasure Island (FL): Stat Pearls Publishing.
  • de Vries, T. P. G. M., Henning, R. H., Hogerzeil, H. V., & Fresle, D. A. (1994). Guide to Good Prescribing. WHO/Action Programme on Essential Drugs, Geneva.
  • Demirkıran, M., & Şahin, B. (2012). Hekimlerin reçete yazma davranışlarının incelenmesi: viral tonsillofarenjit hastalığına ilişkin yazılı hasta olgusu örneği. Sağlıkta Performans ve Kalite Dergisi, 4(2), 19-38.
  • Eksi Alp, E., Oncul, A., Dalgic, N., Akgun, C., Aktas, E., & Bayraktar, B. (2021). Antibiotic stewardship program experience in a training and research hospital. The Medical Bulletin of Sisli Etfal Hospital, 55(2), 253.
  • Gul, Y. A., Hong, L. C., & Prasannan, S. (2005). Appropriate antibiotic administration in elective surgical procedures: still missing the message. Asian Journal of Surgery, 28(2), 104-108.
  • Holloway, K., & Green, T. (2003). Drug and therapeutics committees: a practical guide. (No. WHO/EDM/PAR/2004.1). World Health Organization Department of Essential Drugs and Medicines Policy Geneva, Switzerland.
  • Hosoglu, S., Sunbul, M., Erol, S., Altindis, M., Caylan, R., Demirdag, K., et al. (2003). A national survey of surgical antibiotic prophylaxis in Turkey. Infection Control & Hospital Epidemiology, 24(10), 758-761.
  • Hussain, K., Khan, M. F., Ambreen, G., Raza, S. S., Irfan, S., Habib, K., & Zafar, H. (2020). An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes. Journal of Pharmaceutical Policy and Practice, 13, 1-10.
  • Karaali, C., Emiroglu, M., Esin, H., Sert, I., Aydın, C., Atalay, S., et al. (2020). Assessment of prophylactic antibiotic usage habits of the general surgeons in Turkey. The Journal of Infection in Developing Countries, 14(07), 758-764.
  • Karahocagil, M. K., Er, A., Kırıkçı, A. D., Sünnetçioğlu, M., Yapıcı, K., Bilici, A., et al. (2007). Yüzüncü Yıl Üniversitesi Tıp Fakültesi Araştırma Hastanesinde yatan hastalarda antibiyotik kullanımının incelenmesi. Van Tıp Dergisi, 14(2), 46-51.
  • Khan, Z., Ahmed, N., Rehman, A.ur., Khan, F. U., Saqlain, M., Martins, M. A. P., & Rahman, H. (2020a). Audit of pre-operative antibiotic prophylaxis usage in elective surgical procedures in two teaching hospitals, Islamabad, Pakistan: An observational cross-sectional study. PLoS ONE, 15(4), e0231188.
  • Khan, Z., Ahmed, N., Zafar, S., Khan, F. U., Saqlain, M., Kamran, S., & Rahman, H. (2020b). Audit of antibiotic prophylaxis and adherence of surgeons to standard guidelines in common abdominal surgical procedures. Eastern Mediterranean Health Journal, 26(9), 1052-1061.
  • Khan, F., Chaudhary, B., Sultan, A., Ahmad, M., Alvi, Y., Shah, M. S., & Khan, H. M. (2021). Qualitative thematic analysis of knowledge and practices of surgical antimicrobial prophylaxis at a tertiary care teaching hospital. Surgical Infections, 22(4), 434-441.
  • Knox, M. C., & Edye, M. (2016). Educational antimicrobial stewardship intervention ineffective in changing surgical prophylactic antibiotic prescribing. Surgical Infections, 17(2), 224-228.
  • Koçak, F., Balkan, İ. İ., Çelik, A. D., Durdu, B., Demirel, A., Gencer, S. et al. (2017). Perioperatif antimikrobiyal profilaksi uygulamalarında rehberlere uyum: Çok merkezli bir çalışma. Anadolu Kliniği, 22(1), 8-15.
  • MacCormick, A. P., & Akoh, J. A. (2018). Survey of surgeons regarding prophylactic antibiotic use in inguinal hernia repair. Scandinavian Journal of Surgery, 107(3), 208-211.
  • Madubueze, C. C., Umaru, H., & Alada, A. (2015). Attitudes of Nigerian orthopaedic surgeons to the use of prophylactic antibiotics. International Orthopaedics, 39(11), 2161-2165.
  • Management Sciences for Health. (2012). Managing for Rational Medicine Use. MDS-3: Managing Access to Medicines and Health Technologies. Arlington, VA: Management Sciences for Health.
  • Mmari, E. E., Pallangyo, E. S., Ali, A., Kaale, D. A., Mawalla, I. H., & Abeid, M. S. (2021). Perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital in Tanzania. PloS one, 16(8), e0256134.
  • Ng, R. S., & Chong, C. P. (2012). Surgeons’ adherence to guidelines for surgical antimicrobial prophylaxis–a review. The Australasian Medical Journal, 5(10), 534-540.
  • Organization for Economic Co-operation and Development Health Statistics (OECD). (2021). Pharmaceutical Market: Pharmaceutical consumption. OECD Health Statistics (database) Accessed 11 September 2021, https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_PHMC
  • Pelullo, C. P., Pepe, A., Napolitano, F., Coppola, N., & Di Giuseppe, G. (2020). Perioperative antibiotic prophylaxis: Knowledge and attitudes among resident physicians in Italy. Antibiotics, 9(6), 357.
  • Sartelli, M., Kluger, Y., Ansaloni, L., Coccolini, F., Baiocchi, G. L., Hardcastle, T. C., et al. (2018). Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion. World Journal of Emergency Surgery, 13(1), 1-6.
  • Society for Healthcare Epidemiology of America. (2020). Antimicrobial Stewardship. Accessed 02 Feb 2020, https://www.shea-online.org/index.php/practice-resources/priority-topics/antimicrobial-stewardship.
  • Thabit, A. K., Shea, K. M., Guzman, O. E., & Garey, K. W. (2021). Antibiotic utilization within 18 community hospitals in the United States: A 5‐year analysis. Pharmacoepidemiology and Drug Safety, 30(4), 403-408.
  • Tiri, B., Bruzzone, P., Priante, G., Sensi, E., Costantini, M., Vernelli, C. et al. (2020). Impact of antimicrobial stewardship interventions on appropriateness of surgical antibiotic prophylaxis: How to improve. Antibiotics, 9(4), 168.
  • Tourmousoglou, C. E., Yiannakopoulou, E. C., Kalapothaki, V., Bramis, J., & Papadopoulos, J. S. (2008). Adherence to guidelines for antibiotic prophylaxis in general surgery: a critical appraisal. Journal of Antimicrobial Chemotherapy, 61(1), 214-218.
  • Tünger, Ö., Dinç, G., Özbakkaloğlu, B., Atman, Ü.C., & Algün, Ü. (2000). Evaluation of rational antibiotic use. International Journal of Antimicrobial Agents, 15, 131-135.
  • Ulu-Kilic, A., Alp, E., Cevahir, F., Tucer, B., Demiraslan, H., Selçuklu, A., & Doğanay, M. (2015). Economic evaluation of appropriate duration of antibiotic prophylaxis for prevention of neurosurgical infections in a middle-income country. American Journal of Infection Control, 43(1), 44-47.
  • World Health Organization. (2001). Guidelines for developing national drug policies, 2nd edition. Geneva: World Health Organization. Accessed 24 May 2019, https://apps.who.int/iris/bitstream/handle/10665/42423/924154547X.pdf;jsessionid=27D2EDF8ACC1A8F7DD75EDDD55607BB1?sequence=1
  • World Health Organization. (2003). Introduction to drug utilization research. WHO Library Cataloguing-in-Publication Data, Oslo, Norway.
  • Yılmaz, M., Yılmaz, A., Özyörk, M., Turunç, F., Gürleyik-Erkman, N., Kınalıkaya, A., & Arslan, E. (2018). Akılcı ilaç kullanımı: Düzce’de aile hekimlerinin bilgi ve davranışları. Türkiye Aile Hekimliği Dergisi, 22(1), 20-27.

CERRAHLARIN PROFİLAKTİK ANTİBİYOTİK YÖNETİMİ VE KULLANIMI İLE İLGİLİ BİLGİ VE TUTUMLARI

Year 2023, Volume: 26 Issue: 2, 379 - 392, 23.06.2023

Abstract

Bu araştırmada, iki kamu hastanesinde görev yapan cerrahların cerrahi antibiyotik profilaksi (CAP) kullanma ve kullanmama nedenleri, uygunsuz kullanım nedenleri, antibiyotik kullanımı konusundaki görüş ve önerilerinin incelenmesi amaçlanmıştır. Bu amaçla literatürden yararlanılarak geliştirilen açık ve kapalı uçlu sorulardan oluşan bir soru formu kullanılmıştır. Araştırmanın yürütüldüğü 5 Şubat–6 Eylül 2019 tarihleri arasında bu hastanelerde görev yapan toplam 58 cerrahtan 54’üne ulaşılmış ve soru formu birebir uygulanmıştır. Cerrahlar en fazla kitap ya da bilimsel makalelerin önerilerini (%25,4) kaynak almaktadırlar. CAP uygulama kararı almalarında en fazla postoperatif enfeksiyon oranını artırmaktan kaçınma (8,3±2) ve CAP uygulamama kararı almalarında ise bilgi kaynaklarına tam uyan koşulların var olması (5,9±3,7) nedenlerinin etkili olduğunu belirtmişlerdir. Çoğu cerrah, uygun olmayan CAP kullanımını önemli bir sorun olarak gördüklerini ve uygunsuz kullanımın çoğunlukla gereksiz p rofilaksiden kaynaklandığını belirtmiştir. Cerrahların %75,9’u bir antibiyotik yönetim programının gerekli olduğunu düşünmektedir. Olası bir programda, strateji olarak kullanımın izlenmesi ve geri bildirim sağlanması ve araç olarak hasta risk sınıflandırmasının belirlenmesi için araç kiti ve antibiyogram paketinin kullanılması önerilmektedir. Araştırma bulgularının antibiyotik kullanımını geliştirmeye yönelik antibiyotik yönetimi ve eğitim programlarının geliştirilmesine yardımcı olacağı düşünülmektedir. Elde edilen sonuçların, hastanelerde kurulması planlanan antibiyotik kontrol ekibi ya da antibiyotik yönetim programı açısından faydalı olacağı düşünülmektedir. Özellikle cerrahları hedef alan eğitim programlarına ihtiyaç vardır.

Project Number

-

References

  • Abdel-Aziz, A., El-Menyar, A., Al-Thani, H., Zarour, A., Parchani, A., Asim, M., El-Enany, R., Al-Tamimi, H., & Latifi, R. (2013). Adherence of surgeons to antimicrobial prophylaxis guidelines in a tertiary general hospital in a rapidly developing country. Advances in Pharmacological Sciences, 2013, 1-6.
  • Ahmed, A. M., Nasr, S., Ahmed, A. M., & Elkhidir, O. (2019). Knowledge, attitude and practice of surgical staff towards preoperative surgical antibiotic prophylaxis at an academic tertiary hospital in Sudan. Patient Safety in Surgery, 13(1), 1-6.
  • Badar, V., Parulekar, V. V., & Garate, P. (2018). Study of knowledge, attitude and practice amongst medical professionals about antimicrobial stewardship in tertiary care teaching hospital in India: a questionnaire-based study. International Journal of Basic & Clinical Pharmacology, 7(3), 511.
  • Baniasadi, S., Alaeen, Z., & Shadmehr, M. B. (2016). Surgical antibiotic prophylaxis: a descriptive study among thoracic surgeons. Tanaffos, 15(3), 154.
  • Barlam, T. F., Cosgrove, S. E., Abbo, L. M., MacDougall, C., Schuetz, A. N., Septimus, E. J., et al. (2016). Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 62(10), e51–e77.
  • Binown, K. A., Alhabradi, F. A., Aljahani, A. M., & Shadid, A. M. (2021). Saudi orthopedic surgeons’ knowledge, attitude, and practice regarding surgical antibiotic prophylaxis. Journal of Musculoskeletal Surgery and Research, 1-11.
  • Bohnen, J. M. (2003). Why do surgeons not comply with “best practice”?. Canadian Journal of Surgery, 46(4), 251-2.
  • Centers for Disease Control and Prevention. (2014). Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: US Department of Health and Human Services, CDC.
  • Centers for Disease Control and Prevention. (2019). Antibiotic Use in Hospitals, 2017, Antibiotic Use by Healthcare Setting. Accessed 09 April 2020, https://www.cdc.gov/antibiotic-use/stewardship-report/hospital.html.
  • Crader, M. F., & Varacallo, M. (2019). Preoperative Antibiotic Prophylaxis. Treasure Island (FL): Stat Pearls Publishing.
  • de Vries, T. P. G. M., Henning, R. H., Hogerzeil, H. V., & Fresle, D. A. (1994). Guide to Good Prescribing. WHO/Action Programme on Essential Drugs, Geneva.
  • Demirkıran, M., & Şahin, B. (2012). Hekimlerin reçete yazma davranışlarının incelenmesi: viral tonsillofarenjit hastalığına ilişkin yazılı hasta olgusu örneği. Sağlıkta Performans ve Kalite Dergisi, 4(2), 19-38.
  • Eksi Alp, E., Oncul, A., Dalgic, N., Akgun, C., Aktas, E., & Bayraktar, B. (2021). Antibiotic stewardship program experience in a training and research hospital. The Medical Bulletin of Sisli Etfal Hospital, 55(2), 253.
  • Gul, Y. A., Hong, L. C., & Prasannan, S. (2005). Appropriate antibiotic administration in elective surgical procedures: still missing the message. Asian Journal of Surgery, 28(2), 104-108.
  • Holloway, K., & Green, T. (2003). Drug and therapeutics committees: a practical guide. (No. WHO/EDM/PAR/2004.1). World Health Organization Department of Essential Drugs and Medicines Policy Geneva, Switzerland.
  • Hosoglu, S., Sunbul, M., Erol, S., Altindis, M., Caylan, R., Demirdag, K., et al. (2003). A national survey of surgical antibiotic prophylaxis in Turkey. Infection Control & Hospital Epidemiology, 24(10), 758-761.
  • Hussain, K., Khan, M. F., Ambreen, G., Raza, S. S., Irfan, S., Habib, K., & Zafar, H. (2020). An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes. Journal of Pharmaceutical Policy and Practice, 13, 1-10.
  • Karaali, C., Emiroglu, M., Esin, H., Sert, I., Aydın, C., Atalay, S., et al. (2020). Assessment of prophylactic antibiotic usage habits of the general surgeons in Turkey. The Journal of Infection in Developing Countries, 14(07), 758-764.
  • Karahocagil, M. K., Er, A., Kırıkçı, A. D., Sünnetçioğlu, M., Yapıcı, K., Bilici, A., et al. (2007). Yüzüncü Yıl Üniversitesi Tıp Fakültesi Araştırma Hastanesinde yatan hastalarda antibiyotik kullanımının incelenmesi. Van Tıp Dergisi, 14(2), 46-51.
  • Khan, Z., Ahmed, N., Rehman, A.ur., Khan, F. U., Saqlain, M., Martins, M. A. P., & Rahman, H. (2020a). Audit of pre-operative antibiotic prophylaxis usage in elective surgical procedures in two teaching hospitals, Islamabad, Pakistan: An observational cross-sectional study. PLoS ONE, 15(4), e0231188.
  • Khan, Z., Ahmed, N., Zafar, S., Khan, F. U., Saqlain, M., Kamran, S., & Rahman, H. (2020b). Audit of antibiotic prophylaxis and adherence of surgeons to standard guidelines in common abdominal surgical procedures. Eastern Mediterranean Health Journal, 26(9), 1052-1061.
  • Khan, F., Chaudhary, B., Sultan, A., Ahmad, M., Alvi, Y., Shah, M. S., & Khan, H. M. (2021). Qualitative thematic analysis of knowledge and practices of surgical antimicrobial prophylaxis at a tertiary care teaching hospital. Surgical Infections, 22(4), 434-441.
  • Knox, M. C., & Edye, M. (2016). Educational antimicrobial stewardship intervention ineffective in changing surgical prophylactic antibiotic prescribing. Surgical Infections, 17(2), 224-228.
  • Koçak, F., Balkan, İ. İ., Çelik, A. D., Durdu, B., Demirel, A., Gencer, S. et al. (2017). Perioperatif antimikrobiyal profilaksi uygulamalarında rehberlere uyum: Çok merkezli bir çalışma. Anadolu Kliniği, 22(1), 8-15.
  • MacCormick, A. P., & Akoh, J. A. (2018). Survey of surgeons regarding prophylactic antibiotic use in inguinal hernia repair. Scandinavian Journal of Surgery, 107(3), 208-211.
  • Madubueze, C. C., Umaru, H., & Alada, A. (2015). Attitudes of Nigerian orthopaedic surgeons to the use of prophylactic antibiotics. International Orthopaedics, 39(11), 2161-2165.
  • Management Sciences for Health. (2012). Managing for Rational Medicine Use. MDS-3: Managing Access to Medicines and Health Technologies. Arlington, VA: Management Sciences for Health.
  • Mmari, E. E., Pallangyo, E. S., Ali, A., Kaale, D. A., Mawalla, I. H., & Abeid, M. S. (2021). Perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital in Tanzania. PloS one, 16(8), e0256134.
  • Ng, R. S., & Chong, C. P. (2012). Surgeons’ adherence to guidelines for surgical antimicrobial prophylaxis–a review. The Australasian Medical Journal, 5(10), 534-540.
  • Organization for Economic Co-operation and Development Health Statistics (OECD). (2021). Pharmaceutical Market: Pharmaceutical consumption. OECD Health Statistics (database) Accessed 11 September 2021, https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_PHMC
  • Pelullo, C. P., Pepe, A., Napolitano, F., Coppola, N., & Di Giuseppe, G. (2020). Perioperative antibiotic prophylaxis: Knowledge and attitudes among resident physicians in Italy. Antibiotics, 9(6), 357.
  • Sartelli, M., Kluger, Y., Ansaloni, L., Coccolini, F., Baiocchi, G. L., Hardcastle, T. C., et al. (2018). Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion. World Journal of Emergency Surgery, 13(1), 1-6.
  • Society for Healthcare Epidemiology of America. (2020). Antimicrobial Stewardship. Accessed 02 Feb 2020, https://www.shea-online.org/index.php/practice-resources/priority-topics/antimicrobial-stewardship.
  • Thabit, A. K., Shea, K. M., Guzman, O. E., & Garey, K. W. (2021). Antibiotic utilization within 18 community hospitals in the United States: A 5‐year analysis. Pharmacoepidemiology and Drug Safety, 30(4), 403-408.
  • Tiri, B., Bruzzone, P., Priante, G., Sensi, E., Costantini, M., Vernelli, C. et al. (2020). Impact of antimicrobial stewardship interventions on appropriateness of surgical antibiotic prophylaxis: How to improve. Antibiotics, 9(4), 168.
  • Tourmousoglou, C. E., Yiannakopoulou, E. C., Kalapothaki, V., Bramis, J., & Papadopoulos, J. S. (2008). Adherence to guidelines for antibiotic prophylaxis in general surgery: a critical appraisal. Journal of Antimicrobial Chemotherapy, 61(1), 214-218.
  • Tünger, Ö., Dinç, G., Özbakkaloğlu, B., Atman, Ü.C., & Algün, Ü. (2000). Evaluation of rational antibiotic use. International Journal of Antimicrobial Agents, 15, 131-135.
  • Ulu-Kilic, A., Alp, E., Cevahir, F., Tucer, B., Demiraslan, H., Selçuklu, A., & Doğanay, M. (2015). Economic evaluation of appropriate duration of antibiotic prophylaxis for prevention of neurosurgical infections in a middle-income country. American Journal of Infection Control, 43(1), 44-47.
  • World Health Organization. (2001). Guidelines for developing national drug policies, 2nd edition. Geneva: World Health Organization. Accessed 24 May 2019, https://apps.who.int/iris/bitstream/handle/10665/42423/924154547X.pdf;jsessionid=27D2EDF8ACC1A8F7DD75EDDD55607BB1?sequence=1
  • World Health Organization. (2003). Introduction to drug utilization research. WHO Library Cataloguing-in-Publication Data, Oslo, Norway.
  • Yılmaz, M., Yılmaz, A., Özyörk, M., Turunç, F., Gürleyik-Erkman, N., Kınalıkaya, A., & Arslan, E. (2018). Akılcı ilaç kullanımı: Düzce’de aile hekimlerinin bilgi ve davranışları. Türkiye Aile Hekimliği Dergisi, 22(1), 20-27.
There are 41 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Makaleler
Authors

Aysun Kandemir Türe 0000-0002-3496-5594

Bayram Şahin 0000-0003-2772-3033

Project Number -
Publication Date June 23, 2023
Published in Issue Year 2023 Volume: 26 Issue: 2

Cite

APA Kandemir Türe, A., & Şahin, B. (2023). KNOWLEDGE AND ATTITUDES OF SURGEONS ON THE USE AND STEWARDSHIP OF PROPHYLACTIC ANTIBIOTICS. Hacettepe Sağlık İdaresi Dergisi, 26(2), 379-392.
AMA Kandemir Türe A, Şahin B. KNOWLEDGE AND ATTITUDES OF SURGEONS ON THE USE AND STEWARDSHIP OF PROPHYLACTIC ANTIBIOTICS. HSİD. June 2023;26(2):379-392.
Chicago Kandemir Türe, Aysun, and Bayram Şahin. “KNOWLEDGE AND ATTITUDES OF SURGEONS ON THE USE AND STEWARDSHIP OF PROPHYLACTIC ANTIBIOTICS”. Hacettepe Sağlık İdaresi Dergisi 26, no. 2 (June 2023): 379-92.
EndNote Kandemir Türe A, Şahin B (June 1, 2023) KNOWLEDGE AND ATTITUDES OF SURGEONS ON THE USE AND STEWARDSHIP OF PROPHYLACTIC ANTIBIOTICS. Hacettepe Sağlık İdaresi Dergisi 26 2 379–392.
IEEE A. Kandemir Türe and B. Şahin, “KNOWLEDGE AND ATTITUDES OF SURGEONS ON THE USE AND STEWARDSHIP OF PROPHYLACTIC ANTIBIOTICS”, HSİD, vol. 26, no. 2, pp. 379–392, 2023.
ISNAD Kandemir Türe, Aysun - Şahin, Bayram. “KNOWLEDGE AND ATTITUDES OF SURGEONS ON THE USE AND STEWARDSHIP OF PROPHYLACTIC ANTIBIOTICS”. Hacettepe Sağlık İdaresi Dergisi 26/2 (June 2023), 379-392.
JAMA Kandemir Türe A, Şahin B. KNOWLEDGE AND ATTITUDES OF SURGEONS ON THE USE AND STEWARDSHIP OF PROPHYLACTIC ANTIBIOTICS. HSİD. 2023;26:379–392.
MLA Kandemir Türe, Aysun and Bayram Şahin. “KNOWLEDGE AND ATTITUDES OF SURGEONS ON THE USE AND STEWARDSHIP OF PROPHYLACTIC ANTIBIOTICS”. Hacettepe Sağlık İdaresi Dergisi, vol. 26, no. 2, 2023, pp. 379-92.
Vancouver Kandemir Türe A, Şahin B. KNOWLEDGE AND ATTITUDES OF SURGEONS ON THE USE AND STEWARDSHIP OF PROPHYLACTIC ANTIBIOTICS. HSİD. 2023;26(2):379-92.