Misuse of prophylactic antibiotics and prevalence of postoperative wound infection in obstetrics and gynecology department in a Sudanese hospital

Abstract

Purpose: This study was conducted to audit prophylactic antibiotic use and to quantify the rate of wound infection. Methods: Across-sectional prospective study was conducted in the Obstetrics and Gynecology Department in Khartoum Teaching Hospital, Sudan during March 1st to 31st October 2010. All Patients (aged >18 years) were included. Results: Overall 725 patients were included. The performed surgical procedures were 751; of these 578 (76.9%) were Caesarean sections. Overall rate of wound infection was 7.8%. The rate of wound infection among patients operated on for caesarean section and abdominal hysterectomy was 8.3%, and 9.2%, respectively. Multivariate logistic analysis showed that body mass index [BMI] ≥ 30 kg/m 2 OR 2.1, 95% CI (1.1 -4.0), (P = 0.019) was the major independent risk factor for occurrence of wound infection. Evaluation of prescriptions' parameters against the stated criteria showed that 113 (15.8%) patients were given antibiotics with adequate spectrum of activity, 611 (85.3%) given sub-dose/s, 83 (11.6%) received the first preoperative dose/s in a proper time window, and 716 (100%) had prophylaxis for extended duration. Overall conformity to the stated criteria for the evaluation of prescription's parameters was not achieved in all prescriptions. Conclusions: In this setting, antibiotics were irrationally used and wound infection rate was high, and the situation calls for multiple interventions to correct the situation, through the activation of the infection control committee in the hospital and development of antimicrobial subcommittee to develop policies for the use and auditing of prophylactic antibiotics.

Pattern of Peri-Operative Antibiotic Use among Surgical Patients in a Regional Referral and Teaching Hospital in Uganda

“…A single dose is generally considered sufficient and its effectiveness compared with prolonged post-operative antibiotic use has been proven in several studies in Africa [26]. However, post-operative antibiotic overuse in other African countries has been described [18,27]. The findings of this study were similar to those previously reported: antibiotic overuse was seen even among low-risk patients such as those without SIRS/HAI and those with class 1 wounds.…”

“…Surgical antibiotic prophylaxis and AMR interact closely with each other: declining efficacy of SAP because of AMR could jeopardize safe surgical procedures whereas inappropriate, prolonged SAP could select for resistant microorganisms [16,17]. A study in Sudan showed that SAP was often given inappropriately: all those who received SAP had extended antibiotic use, with an average of eight days whether they developed SSI or not [18]. However, such epidemiologic evidence of inappropriate antibiotic use related to SAP in LMICs is underreported in the literature.…”

Irrational use of antibiotics with representation of antimicrobial resistance patterns in Sudan: a narrative review

“…As part of the irrational use of antibiotics, a study was done in Sudan by (Elbur A et al, 2014) regarding the use of antibiotics as a surgical prophylaxis in obstetrics and gynecology wards given the high rates of surgical site infections. This study revealed 98.8% of admitted cases received antibiotics pre-operatively while 100.0% received antibiotics post-operatively for an average duration of 8 days.…”

“…Surgical site infections are also a leading concern to which the effectiveness of prophylactic antibiotics has been established (8). However, the growing use of prophylactic surgical antibiotics has been associated with resistance.…”

“…Hence, precise selection of the appropriate antibiotic according to the anticipated bacteria at the surgical site as well as accurate timing of the dose and duration are critical. A single dose with a long enough half life to sustain activity throughout the procedure should suffice (8).…”