Evaluation of compliance with the antibiotic prophylaxis protocol in hysterectomy. Prospective cohort study

Abstract

Objectives. Health care-related infections are a public health problem, among them surgical site infection (SSI) are the most frequent in hospitals. The objetive of this study was to assess the effect of the compliance to antibiotic prophylaxis protocol on the incidence of surgical site infection in hysterectomized patients. Material and methods. A prospective cohort study was carried out between October 2009 and December 2018. The incidence of SSI was studied after a maximum period of 30 days from the moment of surgery. The degree of adequacy of antibiotic prophylaxis in hysterectomy and the effect of its inadequacy on the incidence of infection was evaluated using relative risk (RR) adjusted with a logistic regression model. Results. A total of 1,025 interventions were studied in 1,022 women. The cumulative incidence of SSI was 2,1% (n = 22). The most frequent etiology of infection was Escherichia coli (23.1%) and Proteus mirabilis (23.1%). Antibiotic prophylaxis was indicated in 1,014 interventions (98.9%) being administered in 1,009 of them (99.5%). The adherence to the protocol was 92,5%. The main cause of non-compliance was the time of onset (40.9%), followed by the choice of the antibiotic (35.2%). The effect of inadequate prophylaxis on the incidence of infection was RR = 0.9; 95% CI 0.2-3.9; p> 0.05. Conclusions. The adequacy of antibiotic prophylaxis was very high, with a low incidence of surgical site infection. No association was found between adequacy of prophylaxis and incidence of infection in hysterectomy. The continuous improvement of epidemiological surveillance in gynecology should be emphasized.

Compliance with Antibiotic Prophylaxis in Obstetric and Gynecological Surgeries in Two Peruvian Hospitals

“…The present study found that, of the total number of surgeries, antibiotics were used in 94.5%; however, the indication for antibiotic prophylaxis only corresponded to 38.2%. This is different from what was found by Uppendahl and Gil, who, in their respective studies, found a frequency of use of prophylaxis above 95% [19,20], even lower than that described by Romero, in a Latin American context, where the overall use of antimicrobial prophylaxis was 69.9% [13]. The low adherence to prophylaxis in Peru is notorious.…”

“…A study in Israel showed that 95.6% of patients received the correct antibiotic [29]. In contrast, a study in Spain identified the timing of initiation and correct antibiotic selection as the main causes of non-compliance [20]. Importantly, differences in compliance rates could be attributed to the presence of antibiotic optimization and monitoring units in some hospitals.…”

Adequacy of antibiotic prophylaxis and incidence of surgical site infections in neck surgery

“…Monitoring the adequacy of the items of the antibiotic prophylaxis protocols can help controlling SSIs and the antibiotics to be effective, as shows different previous research 35 , 38 , 42 .…”

Análisis de errores con medicamentos en pacientes ingresados en salas de cirugía y recuperación posanestésica de un hospital de alta complejidad en Bogotá, Colombia

“…Durante el proceso de preparación prequirúrgica de todo paciente que ingresa al servicio de salas de cirugía, uno de los aspectos de mayor relevancia es la administración de profilaxis antibiótica (30) , la cual fue administrada a la totalidad de pacientes de la muestra. Sin embargo, un poco menos de la cuarta parte de los pacientes no recibió el medicamento entre 30 y 60 minutos antes de la incisión quirúrgica, de acuerdo con la recomendación dada en diferentes guías y estudios internacionales (31,32,33) , hallando similitud con lo reportado por Gutiérrez et al (34) , quienes identificaron que en el 12% de los casos se presentó este error, exponiendo al paciente a múltiples riesgos, como generar o exacerbar reacciones adversas propias de cada medicamento y/o interacciones farmacológicas al administrar el antibiótico en bolo y en concomitancia con agentes hipnóticos, sedantes, opioides y relajantes musculares durante la inducción de anestesia, además del riesgo aumentado de desarrollar infección del sitio operatorio al no alcanzar concentraciones óptimas del fármaco en los tejidos antes de ser expuestos a la incisión quirúrgica (34,35,36,37) .…”