# Antibiotic Use in Surgical Wards: A Point Prevalence Survey Based on the WHO AWaRe Methodology

## TL;DR

This study analyzed antibiotic use in surgical wards in an Italian hospital using WHO guidelines to assess patterns and identify areas for improvement.

## Contribution

The study integrates WHO AWaRe classes with DDDs to evaluate surgical antibiotic prophylaxis at a detailed, specialty-specific level.

## Key findings

- Cefazolin was the most commonly used antibiotic for surgical prophylaxis, accounting for 82% of prescriptions.
- 93% of surgical antibiotic prophylaxis prescriptions were classified as WHO Access agents.
- The study highlights variations in antibiotic use across surgical specialties, offering tools for quality improvement.

## Abstract

Background/Objectives: In surgical antibiotic prophylaxis (SAP), most studies continue to report the number of prescriptions aggregated at the hospital level, rarely integrating the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classes with standardized volume indicators. This study aimed to evaluate the utilization of antibiotics for SAP in a large Italian teaching hospital using both the number of prescriptions and defined daily doses (DDDs) and mapped the AWaRe models across different surgical specialties to highlight differences relevant to management. Methods: We conducted a prospective hospital-wide surveillance of all consecutive patients undergoing surgical procedures between March and May 2023 at the Azienda Ospedaliero-Universitaria delle Marche. Data included demographics, surgical specialty, and all antibiotic administrations with indication. For SAP, each prescription was classified according to the 2023 WHO AWaRe framework, and consumption was quantified using the WHO ATC/DDD methodology. Results: A total of 914 patients were monitored, with complete antibiotic data for 793 (86.8%). Among 433 SAP prescriptions, the most frequently used agent was cefazolin (82%), followed by amoxicillin/β-lactamase inhibitor (5%) and metronidazole (5%). According to AWaRe, 93% of SAP prescriptions were Access agents and 7% were Watch agents; no Reserve antibiotics were used. When expressed in DDDs (total: 443.5), 87.8% were Access and 12.2% Watch. Cefazolin accounted for over 85% of Access DDDs. Conclusions: By combining AWaRe classes with DDDs and resolving results by surgical specialty, this study extends hospital-level metrics and provides a pragmatic framework for SAP benchmarking. The predominance of Access agents is consistent with management objectives, while differences across specialties identify concrete tools for local quality improvement.