Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications

Abstract

Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post-operatively. However, there are concerns with the extent of prophylaxis post-operatively, especially in low- and middle-income countries (LMICs). This increases antimicrobial resistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study on 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. The identified variables included post-operative prophylactic antimicrobials given to all patients for all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures, and among these, the use of third-generation cephalosporins was common. The duration of post-operative prophylaxis was 3–4 days, appreciably longer than the suggestions of the guidelines, with most patients prescribed antimicrobials until discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration need to be addressed. This includes appropriate interventions, such as antimicrobial stewardship programs, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and to reduce AMR.

11-Year Trend in Antibiotic Consumption in a South-Eastern European Country; the Situation in Albania and the Implications for the Future

“…However, there have been concerns in previous studies with prolonged antibiotic administration post-surgery to reduce SSIs in Albania [44]. This may be driven by concerns with coverage and resistance rates, with the potential for greater prescribing of 'Watch' antibiotics if there is high empiric prescribing with currently limited culture and sensitivity testing in hospitals in Albania, which is similar to a number of other countries documented in recent studies and reviews among LMICs [58,59]. Again, we are unable to comment further without additional research.…”

Point prevalence of evidence-based antimicrobial use among hospitalized patients in sub-Saharan Africa: a systematic review and meta-analysis

“…A lower point prevalence of medical prophylaxis in SSA suggests limited access and utilization of preventative medical interventions 105 . This may be indicative of healthcare system challenges, resource constraints, or insufficient awareness and education 106 , 107 . It can result in a higher disease burden, increased healthcare costs, and potentially poorer clinical and public health outcomes for the population 10 , 108 .…”

Antibiotic Stewardship in Surgical Departments

“…When prophylaxis is used the proper way, the risk of C. difficile infection is not higher [61]. Compliance with SAP policies has generally been lower in LMICs [62].…”