Orthopaedic surgical antibiotic prophylaxis administration compliance with prescribing guidelines in a private hospital in North West province, South Africa

Abstract

BACKGROUND: The correct use of surgical antibiotic prophylaxis (SAP), as stipulated in evidence-based guidelines, is essential to prevent surgical site infections (SSIs) following orthopaedic procedures and consequently the impact thereof on the patient and healthcare system. Orthopaedic SSIs are associated with devastating complications with a great burden of disease on patients. METHODS: A cross-sectional study was performed in a 186-bed private hospital, located in North West province, South Africa. Retrospective data of adult patients who underwent orthopaedic surgery from 1 January 2020 to 31 December 2020 were included. Data were obtained from the study hospital's theatre registers, anaesthetic notes, patient medical records and patient antimicrobial prescription charts. Descriptive statistical analysis was used to determine the compliance (indication, choice, route of administration, dose, administration time, re-dosing and duration) of orthopaedic SAP administration with prescribing guidelines. RESULTS: Of the 942 orthopaedic procedures, SAP was correctly administered or omitted in 742 cases (78.8%). The total choice of SAP was correct in 738 cases (78.3%). SAP was administered intravenously 100% of the time and was prescribed at the correct dose in 632 cases (77.5%). However, SAP re-dosing occurred only in one of the three prolonged procedures, and the preoperative SAP administration time was only indicated in 34.4% of the cases. The correct duration of SAP was 75.9%. The overall compliance rate to SAP guidelines regarding indication, choice, dose and duration was 57.5%. SSIs developed in 0.9% of the patients, resulting in the death of one. CONCLUSION: Orthopaedic SAP practices moderately deviated from current SAP guidelines. Apparent overuse, incorrect dosing and prolonged duration were identified as burdens to overcome. Special attention should be paid to dosing adjustments for patients weighing more than 120 kg. However, certain components such as route of administration, administration time, SAP indication and SAP correct choice showed greater compliance percentages. The low prevalence of SSIs supports a positive reporting of the findings Level of evidence: Level 4.

Enhancing Surgical Outcomes: A Critical Review of Antibiotic Prophylaxis in Orthopedic Surgery

“…On the other hand, reducing the length of time that antibiotic prophylaxis is taken can help lower the risk of antibiotic resistance. When deciding whether to start taking antibiotics and for how long, orthopedic surgeons and other healthcare practitioners need to stick to the established recommendations and take the patient's unique circumstances into account [31][32][33][34][35][36][37].…”

“…This scheduling guarantees that a suitable concentration of the medicine will be present in the bloodstream throughout the surgical process. If antibiotics are administered too early, this might result in medication levels that are less than ideal during surgery; nevertheless, if they are administered too late, this could result in inadequate protection [33][34][35].…”

“…There are a variety of patient-specific characteristics that might influence the antibiotics used, the administration schedule, and the length of treatment. Prophylaxis may need to be administered for a longer period of time to patients who are at a higher risk, such as those who have diabetes, obesity, or a weaker immune system [31][32][33][34][35][36][37].…”

“…Antibiotic resistance considerations: Even though the benefits of using antibiotics for preventative purposes are obvious, antibiotic stewardship is still very important [33][34][37][38]. Reduce the usage of antibiotics when they are not required, choose drugs appropriately, and adhere closely to dosage instructions.…”