Antibiotic usage in surgical prophylaxis: A prospective observational study in the surgical ward of Nekemte referral hospital

Abstract

BackgroundSurgical antimicrobial prophylaxis guidelines are considered as important interventional tools for antimicrobial resistance. Guideline compliance was poor across different countries and thus results in an inappropriate and overuse of antibiotics.ObjectiveTo evaluate the selection, timing and duration of prophylactic antibiotic administration among surgical patients in Nekmte referral hospital.MethodProspective, facility based cross-sectional study was conducted from 1st April to 30th June 2017. Data were collected using data abstraction format among surgical inpatients prescribed with surgical antibiotic prophylaxis. Surgical antimicrobial prophylaxis guidelines were used as data assessment protocols. SPSS version 21.0 was used for data entry and analysis. Descriptive statistics and binary logistic regression were used for analysis.ResultsThe median age of the study participants was 35.0 (IQR: 25–50) years with the preponderance (58.8%) of male patients. The median hospitalization period was 8.0 (IQR: 5–11) days. Majority of the participants were from the general surgical ward (60.1%). About 43% of the procedures were clean. Most of the surgical cases were gastrointestinal (39.2%). Only 10.6% of the drug selections comply with American Society of Health-System Pharmacists guideline. Surprisingly, none of the selections were compliant to the national Standard Treatment Guideline of the country. About 84% of the study participants received ceftriaxone. Majority of the prophylactic antibiotics (75.8%) were administered for greater than 24 hours and above half (52.3%) of the antibiotics were administered preoperatively. Emergent surgery procedures (AOR = 2.89, 95% CI: (1.09–9.10) and being a male patient (AOR = 3.10, 95% CI: 1.07–8.98) were associated with inappropriate preoperative antibiotic administration. Patients admitted to the gynecology and obstetrics ward was less likely to receive surgical prophylaxis for greater than 24 hours (AOR = 0.07, 95% CI: 0.01–0.81).ConclusionSurgical antibiotic compliance was far below the guideline recommendation. Patients admitted in the gynecology and obstetrics ward were more likely to comply with the surgical antimicrobial prophylaxis duration recommendation. The timing was most likely to be inappropriate among male patients and patients on emergent surgery. Availability and awareness creation on the antibiotic drugs and the guidelines were important interventions recommended for appropriate surgical antimicrobial use.

Pattern of Surgical Antibiotic Prophylaxis for Surgical Site Infections in at two Teaching Hospitals, Islamabad, Pakistan

“…However, our study reported that the most common class of antibiotics was Cephalosporins specifically, ceftriaxone was mostly prescribed to managed surgical procedures. These findings are aligned with Ethiopian studies [1,2] and similar results also reported in Malaysian [23], Turkish [5] and Iranian [22] studies. Whereas, these findings have deviated from previously conducted studies in Singapore, Greece, Germany, and Italy which showed most common antibiotics were cefazolin, ceforanide, cefuroxime, and levofloxacin respectively [16,18,24,25].…”

“…Ceftriaxone and cefazolin were the most commonly prescribed agent as SAP, while ceftriaxone alone being given to 48.3% patients in all surgeries. These findings are aligned with studies conducted in different countries [1,2,6,22] which indicates over usage of antimicrobials in surgical procedures. This may be due to the lack of updated information, continuous training, awareness, and adherence with international and local evidence-based treatment guidelines among prescribers of surgical wards [1,2,18].…”

“…Surgical site infection (SSI) is one of the drastic post-operative complications and ultimately affect the overall quality of life due to increased morbidity, mortality and treatment cost [1,2]. Surgical antibiotic prophylaxis (SAP) administration before surgery is an evidencebased practice for the prevention of SSI [3,4].…”

“…Surgical antibiotic prophylaxis (SAP) administration before surgery is an evidencebased practice for the prevention of SSI [3,4]. However, the nature of the pathogen, pharmacokinetic profile of therapeutic agent, correct timing, dose and route according to the patient and surgical procedure are crucial for appropriate prophylaxis [1]. Despite the authentic evidence about the SAP effectiveness, its use often inappropriately reported by different studies [1,2,5].…”

“…Despite the authentic evidence about the SAP effectiveness, its use often inappropriately reported by different studies [1,2,5]. Inappropriate choice, timing and the duration of the SAP were commonly reported [1,2,6]. As a result, irrational use of SAP ultimately leads to the increased cost of therapy, resistance and adverse drug reaction [2][3][4].…”