Appropriateness of surgical antimicrobial prophylaxis in a teaching hospital in Ghana: findings and implications

Abstract

Background Surgical site infections (SSIs) are among the most common infections seen in hospitalized patients in low- and middle-income countries (LMICs), accounting for up to 60% of hospital-acquired infections. Surgical antimicrobial prophylaxis (SAP) has shown to be an effective intervention for reducing SSIs and their impact. There are concerns of inappropriate use of SAP in Ghana and therefore our audit in this teaching hospital. Methods A retrospective cross sectional clinical audit of medical records of patients undergoing surgery over a 5 month duration from January to May 2021 in Ho Teaching Hospital. A data collection form was designed to collect key information including the age and gender of patients, type and duration of surgery, choice and duration of SAP. The collected data was assessed for the proportion of SAP compliance with Ghana Standard Treatment Guidelines (STGs) and any association with various patient, surgical wound and drug characteristics. Results Of the 597 medical records assessed, the mean age of patients was 35.6 ± 12.2 years with 86.8% (n = 518) female. Overall SAP compliance with the STG was 2.5% (n = 15). SAP compliance due to appropriate choice of antimicrobials was 67.0% (n = 400) and duration at 8.7% (n = 52). SAP compliance was predicted by duration of SAP (P < 0.000) and postoperative hospitalization duration (P = 0.005). Conclusions SAP compliance rate was suboptimal, principally due to a longer duration of prescription. Quality improvement measures such as education of front-line staff on guideline compliance, coupled with clinical audit and regular updates, are urgently needed to combat inappropriate prescribing and rising resistance rates.

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

“…Here we also concentrate on the extent of inappropriate prescribing of antibiotics post-operatively to prevent SSIs. It is important that antibiotic prophylaxis is administered for the appropriate duration to prevent SSIs as they are responsible for an appreciable number of hospital-acquired infections, impacting on morbidity, mortality and costs [ 141 , 142 , 143 , 144 , 145 ]. However, as mentioned, extended prophylaxis increases AMR and adverse reactions with limited or no impact on further reducing SSIs [ 83 , 141 , 146 ].…”

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

“…Healthcare-associated infections (HAIs) are a common adverse event in hospitals, resulting in increased length-of-stay, morbidity and mortality as well as increased costs [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. In higher-income countries (HIC), device-associated infections are the most common HAI, while among low-and middle-income countries (LMICs), surgical-site infections (SSIs) are the most common HAI [ 7 , 9 , 10 , 11 , 12 ]. Consequently, these patients need to be carefully managed to prevent SSIs, especially in LMICs.…”

“…The rate of SSIs varies considerably according to the hospital setting, experience of the surgeon, the surgical procedure and the country [ 7 , 17 , 18 , 22 ]. Reported prevalence rates vary between 3% to 50% of surgical procedures, with typically appreciably higher prevalence rates among LMICs [ 11 , 12 , 17 , 23 , 24 , 25 ]. Reported prevalence rates in the United Kingdom and United States of America (USA) for SSIs vary between 16% and 31% [ 19 , 26 ].…”

“…In Pakistan, SSI rates can vary from 6.5% up to 33.7% of patients admitted to surgical wards [ 27 , 28 , 29 ]. Overall, SSIs can account for up to 60% of HAIs in LMICs [ 1 , 9 , 11 , 30 , 31 ]. In view of this, the management of surgical patients requires careful scrutiny to improve future care and reduce costs.…”

“…Surgical procedures have been classified into four categories, i.e., Clean, Clean/Contaminated, Contaminated and Dirty, with increasing frequency of bacterial impurity and post-operative infections [ 15 , 32 , 33 ]. Surgical antimicrobial prophylaxis (SAP) is the administration of antimicrobials before or after surgical procedures to prevent post-operative SSIs [ 11 , 17 , 34 ].…”