<p>Surgical Site Infections and Prophylaxis Antibiotic Use in the Surgical Ward of Public Hospital in Western Ethiopia: A Hospital-Based Retrospective Cross-Sectional Study</p>

Abstract

Objective: Surgical site infection (SSI) is one of the leading causes of hospital-acquired infection among hospitalized patients. It causes significant health problems and results in an extended length of hospital stay, increased cost, and increased patient morbidity and mortality. To prevent the development of SSI, surgical antibiotic prophylaxis (SAP) administration before surgery is an evidence-based practice. Therefore, this study aimed to assess the prevalence of SSIs and surgical antibiotic prophylaxis practice, and identifying the gap in practicing prophylactic surgical antibiotic use. Methods: A retrospective cross-sectional study design was conducted on randomly selected 281 participants who fulfilled the inclusion criteria. Appropriateness of surgical antibiotic prophylaxis was assessed by clinical pharmacists based on the standard treatment guideline. Descriptive and multivariate logistic regression analyses were performed in SPSS version 25. Statistical significance was set at p <0.05. Results: The overall prevalence of SSI was 19.6% (95% CI: 19-20.2). Majority of surgical patients (88.6%) got surgical antibiotic prophylaxis. Ceftriaxone and metronidazole (45.4%), and ceftriaxone (33.3%) were the most frequently used prophylactic antibiotics. Presence of comorbidity (AOR=9.18, 95% CI: 5.17-17.9, p<0.001), contaminated (AOR=6.01, 95% CI: 1.77-16.8, p=0.019) and dirty (AOR=7.20, 95% CI: 1.23-12.1, p=0.029) wound classes, devoid of prophylactic antibiotics (AOR=6.63, 95% CI: 0.89-19.3, p=0.006), the timing of prophylactic antibiotic administration between 1 hour and 2 hours before incision (AOR=8.2, 95% CI: 4.34-18.1, p=0.001), and 48 hours duration of surgical antimicrobial prophylaxis (AOR=7.20, 95% CI: 1.23-28.17, p=0.027) were significantly associated with the development of SSIs. Conclusion: The prevalence of SSI was relatively high despite most surgical patients were given prophylactic antibiotics. The presence of comorbidity, contaminated and dirty wound classes, devoid of prophylactic antibiotics, administering prophylactic antibiotics between 1 hour and 2 hours before incision, and 48 hours duration of surgical antibiotic prophylaxis were significantly associated with SSIs.

Hospital Antibiotic Prescribing Pattern in General Surgery Specialty: Analysis Based on the WHO Access, Watch and Reserve (AWaRe) Classification

“…The most remarkable finding of the study is that monotherapy (64.9%) was chosen over combination therapy since most preventive antibiotics were administered empirically, with cephalosporins accounting for 56.8 percent of all antibiotic encounters. Ceftriaxone was the most usually administered third generation cephalosporin in most surgeries; however, cefotaxime or cefoperazone was apparently the most regularly prescribed third generation cephalosporin in a few studies [17,[27][28][29][30]. It has been reported that the most common therapeutic errors in general surgery were administration of second-or third-line antibiotics without indication and use of antibiotics when they were not required [31,32].…”

Current practices and evaluation of barriers and facilitators to surgical site infection prevention measures in Jimma, Ethiopia

“…Our finding that ceftriaxone alone was commonly used for preoperative antibiotic prophylaxis matches other reports from Ethiopia. 21,22 A 2019 report from a government hospital in southern Ethiopia found that ceftriaxone reasonably covers most pathogens implicated in SSIs from clean procedures based on local susceptibility patterns, though first-generation cephalosporins, such as cephazolin, are generally preferred for most procedures to reduce antimicrobial resistance. 8,23,24 Unfortunately, several studies from Ethiopia suggest first-generation cephalosporins are less widely available than ceftriaxone.…”

Review of the Appropriateness of Surgical Antimicrobial Prophylaxis

“…Chautrakarn et al and Kefale et al reported inappropriate use of antibiotics in the surgical ward; mainly due to the inappropriate selection of antibiotics [58,59]. Tiri et al reported that out of 2059 elective surgical procedures, the dose was appropriate with a rate of 69.7% and that the choice of antibiotic was appropriate with a rate of 78.4% [40].…”